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Recurrent episodes of falls and amnestic confusional states as diagnostic challenge in the elderly
  1. Yulia Novitskaya1,
  2. Katrin Götz-Trabert1,2 and
  3. Andreas Schulze-Bonhage1
  1. 1 Epilepsy Center, University Medical Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
  2. 2 Neurologist Practice, Freiburg, Baden-Württemberg, Germany
  1. Correspondence to Professor Andreas Schulze-Bonhage, andreas.schulze-bonhage{at}


New-onset paroxysmal events in patients over 60 years of age are often diagnostically challenging owing to atypical presentation. Recurrent falls and transient states of confusion are especially common in the elderly population, yet their causes often remain undiagnosed due to concomitant cognitive deficits and motor impairments. We present an elderly patient with newly occurring ‘blackouts’ without obvious triggers and transient states of confusion for which he was amnestic. All neurological exams including brain MRI scan and routine electroencephalography (EEG) were normal. Long-term ECG monitoring using an event recorder captured an asystole during a habitual episode, leading to the diagnosis of syncope and pacemaker implantation. A subsequent video EEG monitoring performed due to ongoing unexplained confusional states revealed both bradycardia and long-lasting confusional states to be caused by unrecognised temporal lobe seizures. Ictal video EEG monitoring may play a crucial role in establishing a diagnosis of atypical temporal lobe seizures in the elderly.

  • epilepsy and seizures

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  • Contributors YN was responsible for working with the patient data, reviewing the pertinent articles related to the topic under supervision of AS-B, as well as a major contributor to drafting the paper and preparing the figures and the video file. AS-B contributed to the design and writing of the report and provided critical revision of the draft. KG-T provided critical revision and correction of the draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed. - correct.

  • Patient consent for publication Obtained.

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