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

Abstract

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