Reappraisal of Palinopsia as a Disregarded Symptom in Epilepsy: A Case Report and Systematic Review of the Related EEG Findings

Abstract

Objective

To present a case of epileptic palinopsia successfully treated with lamotrigine and systematically review EEG findings, clinical features, and treatment outcomes of epileptic palinopsia.

Methods

We report a 58-year-old male with right occipital hemorrhage who developed seizures characterized by palinoptic phenomena four years post-injury. A systematic review of available cases was conducted using PRISMA guidelines and multiple databases (PubMed, Scopus, Embase, and Web of Science) through December 2024.

Results

The patient's seizures included visual perseveration followed by bilateral tonic-clonic activity and achieved a >50% reduction in palinoptic phenomena with lamotrigine treatment over 20 months. Interictal EEG showed sharp and slow wave activity in the right temporal region, while MRI revealed right occipital encephalomalacia. The systematic review identified 40 cases from 34 articles (mean age 50.56 ± 16.10 years, 65.0% male). Interictal EEG abnormalities were present in 70.0% of cases, predominantly spikes/sharp waves (60.7%) localized to the right temporal and occipital regions. Ictal EEG recordings were available in 22.5% of cases. Both interictal (71.4%) and ictal (71.4%) findings demonstrated right-hemisphere predominance, particularly in the occipital region (30% of all cases, with 58.3% being right-sided). Structural abnormalities were identified in 26 cases, with tumors (42.3%) being the most common etiology. Anti-seizure drugs were prescribed in 57.5% of cases.

Conclusion

Our study highlights palinopsia as an overlooked seizure symptom with potential right hemispheric lateralization. Recognizing its EEG and neuroimaging patterns is essential for early diagnosis and treatment. Clinicians should maintain a high suspicion for epileptic palinopsia in patients with structural brain lesions involving temporo-occipital regions.

Keywords

palinopsia epilepsy case report electroencephalography (EEG)occipital lobe epilepsy anti-seizure drugs (ASDs)

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References

Critchley

. Types of visual perseveration: “paliopsia” and “illusory visual spread”. Brain. 1951;74(3):267–299.

Stagno

Gates

. Palinopsia: A review of the literature. Behav Neurol. 1991;4(2):67–74.

Bender

Feldman

Sobin

. Palinopsia. Brain. 1968;91(2):321–338.

Abert

Ilsen

. Palinopsia. Optometry J Am Optometric Assoc. 2010;81(8):394–404.

Takeda

. Brain mechanisms of visual long-term memory retrieval in primates. Neurosci Res. 2019;142(1):7–15.

Phylactou

Shimi

Konstantinou

. Causal evidence for the role of the sensory visual cortex in visual short-term memory maintenance. R Soc Open Sci. 2023;10(4):230321.

Bettencourt

. Decoding the content of visual short-term memory under distraction in occipital and parietal areas. Nat Neurosci. 2016;19(1):150–157.

Onomura

Shimizu

Kobayashi

, et al. Palinopsia as an initial symptom of cerebral amyloid angiopathy-related inflammation. eNeurologicalSci. 2021;25(1):100375.

Cummings

Syndulko

Goldberg

Treiman

. Palinopsia reconsidered. Neurology. 1982;32(4):444–447.

10.

León-Ruiz

Oliva-Navarro

. Palinopsia with LPDs-plus heralding a posterior–cerebral–artery ischemic stroke: the hidden face of occipital lobe seizures. Acta Neurol Belg. 2023;123(2):679–682.

11.

Swash

. Visual perseveration in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry. 1979;42(6):569–571.

12.

Gersztenkorn

Lee

. Palinopsia revamped: a systematic review of the literature. Surv Ophthalmol. 2015;60(1):1–35.

13.

Lefebre

Kölmel

. Palinopsia as an epileptic phenomenon. Eur Neurol. 1989;29(6):323–327.

14.

Kataoka

Ueno

. Cerebral polyopia and palinopsia in a patient with occipital lobe epilepsy. Epilepsy Behav. 2009;14(4):684–686.

15.

Meadows

Munro

. Palinopsia. J Neurol Neurosurg Psychiatry. 1977;40(1):5–8.

16.

Wells

Shea

, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, 2014.

17.

Moher

Liberati

Tetzlaff

Altman

. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

18.

Brust

JCM

Behrens

. “Release hallucinations” as the major symptom of posterior cerebral artery occlusion: a report of 2 cases. Ann Neurol. 1977;2(5):432–436.

19.

Jacobs

. Visual allesthesia. Neurology. 1980;30(10):1059.

20.

Cleland

Saunders

Rosser

. An unusual case of visual perseveration. J Neurol Neurosurg Psychiatry. 1981;44(3):262–263.

21.

Eretto

Schoen

Krohel

Pechette

. Palinoptic visual allesthesia. Am J Ophthalmol. 1982;93(6):801–803.

22.

Landis

Cummings

Christen

Bogen

Imhof

H-G

. Are unilateral right posterior cerebral lesions sufficient to cause prosopagnosia? Clinical and radiological findings in six additional patients. Cortex. 1986;22(2):243–252.

23.

Ardila

Botero

Gomez

. Palinopsia and visual allesthesia. Int J Neurosci. 1987;32(3-4):775–782.

24.

Johnson

Loge

. Palinopsia due to nonketotic hyperglycemia. West J Med. 1988;148(3):331–332.

25.

Lefébre

Kölmel

. Palinopsia as an epileptic phenomenon. Eur Neurol. 1989;29(6):323–327.

26.

Young

Heros

Ehrenberg

Hedges

. Metamorphopsia and palinopsia. Association with periodic lateralized epileptiform discharges in a patient with malignant astrocytoma. Arch Neurol. 1989;46(7):820–822.

27.

Purvin

Bonnin

Goodman

. Palinopsia as a presenting manifestation of creutzfeldt-jakob disease. J Neuroophthalmol. 1989;9(4):242–246.

28.

Müller

Büttner

Kuhn

Heinz

Przuntek

. Palinopsia as sensory epileptic phenomenon. Acta Neurol Scand. 1995;91(6):433–436. doi:10.1111/j.1600-0404.1995.tb00442.x

29.

Ogunyemi

Adams

. Migraine-like symptoms triggered by occipital lobe seizures: response to sumatriptan. Can J Neurol Sci. 1998;25(2):151–153.

30.

Fournier

Zackon

. Palinopsia: a case report and review of the literature. Can J Ophthalmol. 2000;35(3):154–157.

31.

Miao

, et al. Case report: PRES-like syndrome with reversible cortical blindness associated with essential thrombocythemia. Front Neurol. 2021;12(12):743165.

32.

Smith

PEM

Shah

Sharpe

Todd

Goringe

. Palinopsia. Lancet. 2003;361(9363):1098.

33.

Sun

Y-T

Lin

C-CK

. Sequential appearance and disappearance of hemianopia, palinopsia and metamorphopsia: a case report and literature review. Acta Neurol Taiwan. 2004;13(2):77–83.

34.

Kondziella

Maetzel

. The sting in the tail: syncope and palinopsia. J Neurol. 2006;253(5):657–658.

35.

Mitsueda-Ono

Ikeda

Noguchi

, et al. Epileptic polyopia with right temporal lobe epilepsy as studied by FDG-PET and MRI: a case report. J Neurol Sci. 2006;247(1):109–111.

36.

Engelsen

Tzoulis

Karlsen

, et al. POLG1 Mutations cause a syndromic epilepsy with occipital lobe predilection. Brain. 2008;131(3):818–828.

37.

Gavaret

Guedj

Koessler

, et al. Reading epilepsy from the dominant temporo-occipital region. J Neurol Neurosurg Psychiatry. 2010;81(7):710–715.

38.

Ossola

Romani

Tavazzi

Pichiecchio

Galimberti

. Epileptic mechanisms in Charles Bonnet syndrome. Epilepsy Behav. 2010;18(1):119–122.

39.

Curlo

Popovic

Riccardo

Sacco

. Palinopsia in a patient with a left pericalcarine cavernous haemangioma, 2012.

40.

Murakami

Ichikawa

Sugimoto

, et al. Perceiving “ghost” images: a unique case of visual allesthesia with hemianopsia in mitochondrial disease. Neuropsychiatr Dis Treat. 2014;10(10):999–1002.

41.

Canafoglia

Morbin

Scaioli

, et al. Recurrent generalized seizures, visual loss, and palinopsia as phenotypic features of neuronal ceroid lipofuscinosis due to progranulin gene mutation. Epilepsia. 2014;55(6):e56–e59. doi:10.1111/epi.12632

42.

Elsayed

Makdum

Salim

Razak

NSA

. Palinopsia as a rare presenting symptom of occipital stroke “case report”. Case Rep Clin Med. 2021;10(7):203–212.

43.

McDonald

Bursztyn

Alexander Fraser

. Movie-Like palinopsia. J Neuroophthalmol. 2023;43(2):e63–e64.

44.

Baykan

Kinay

Gökyigit

Gürses

. Periodic lateralized epileptiform discharges: association with seizures. Seizure. 2000;9(6):402–406.

45.

Chong

Hirsch

. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol. 2005;22(2):79–91.

46.

Kalita

Uniyal

Bhoi

. Is palinopsia in migraineurs an enhanced physiological phenomenon? Cephalalgia. 2016;36(13):1248–1256.

47.

Hughes

Lessell

. Trazodone-induced palinopsia. Arch Ophthalmol. 1990;108(3):399–400.

48.

Licchetta

Ferri

Morsillo

, et al. Clinical characterization of non-ketotic hyperglycemia-related seizures: a systematic review and individual participant data meta-analysis. Seizure. 2023;106(March 2023):50–57.

49.

Benwell

Harvey

Thut

. On the neural origin of pseudoneglect: EEG-correlates of shifts in line bisection performance with manipulation of line length. Neuroimage. 2014;86(100):370–380.