Experiential seizures related to the hippocampal-parahippocampal spatial representation system

Abstract

Ictal visual hallucinations may have occipital as well as temporal lobe origin. We report a patient with clustering of focal aware seizures with visual hallucinations. Ictal EEG findings and seizure semiology with alternating contralateral elementary visual phenomena and non-lateralizing experiential hallucinations (visual scenes, memory flashbacks, spatial distortion) corresponded to a lesion in the posterior part of the right parahippocampal gyrus. This area is part of the hippocampal-parahippocampal system for mapping allocentric space. Within this system, the parahippocampal cortex encodes information about visual environmental scenes in concert with functionally defined neurons relevant for episodic memory and spatial cognitive processes (place, grid, border and head direction cells, as well as neurons tracking the passage of time). These functions are tightly linked to visual exploration. We suggest that the hippocampal-parahippocampal spatial navigation system is a crucial part of the networks responsible for the semiology of experiential seizures with complex visual hallucinations and elements of recall.

An Unusual Presentation of Vivid Hallucinations

“…Complex hallucinations differ in that these present as formed images of objects, animals, people, and lifelike scenes [ 5 ]. Traditionally, hallucinations initiated in the occipital lobe are described as elementary in nature, and these simple hallucinations are experienced as bright spots or simple geometric shapes, commonly restricted to one visual field [ 6 ]. Complex hallucinations are rarely occipital in origin.…”