“A new type of dementia—called seizures”: temporal lobe epilepsy presenting as episodic neuropsychiatric symptoms

Introduction: Older adults frequently present with episodic mood changes and fluctuating memory lapses, which can be mistaken for depression or early neurodegenerative disease. Astute clinicians know that through careful history, physical, and appropriate test examinations, the dangerous can be differentiated from the benign. Case presentation: We report the case a 75-year-old woman who presented after a transient episode of syncope with brief tremulous movements and seizure-like activity. Her history included sudden, unpredictable waves of sadness and intermittent memory lapses, rather than persistent low mood or steadily progressive cognitive decline. Initial evaluation, including imaging and cardiovascular studies, was unremarkable, and her presentation was initially attributed to medication-related bradycardia. Neurological testing, however, revealed three seizure events on spot Electroencephalogram (EEG), fourteen seizures on continuous EEG over 24 h, and associated structural abnormalities on Magnetic Resonance Imaging (MRI) localizing to the left temporal lobe. Discussion: This case highlights how episodic affective and cognitive symptoms can closely mimic or co-exist with primary psychiatric or neurodegenerative disorders. Recognition of these atypical patterns is critical as untreated seizures can cause significant morbidity. Timely identification and management may also substantially improve overall functioning and quality of life, while avoiding unnecessary treatments and their adverse side effects. Conclusions: Clinicians should maintain a high index of suspicion for transient neurological events in older adults presenting with atypical mood changes, fluctuating memory, or subtle automatisms.