Special report. The nature of aggression during epileptic seizures

Specific stimulus-evoked violent action in psychotic trigger reaction: a seizure-like imbalance between frontal lobe and limbic systems?

A recently proposed diagnostic class, psychotic trigger reaction, is deduced from careful clinical studies of eight white men, who upon a very specific trigger stimulus committed murder or attempted to (and in one case also rape). The new class is defined as a sudden ego-alien, motiveless (at least with respect to aggression), motor-wise well organized, violent complex action without emotional concomitants. The action is evoked (not provoked) by an individually unique stimulus within a specific context reviving repeated past traumatic experience. Typically there is no (significant) loss of consciousness and practically full recall. Observed are first-time hallucinations (visual, auditory, tactile, somesthetic, but not olfactory as in temporal lobe epilepsy) and signs of imbalance in the autonomic nervous system (loss of bladder control, ejaculation, profuse sweating, nausea). Only four of these men had previous psychiatric diagnoses (and then various ones) or abnormal EEGs at some time in their lives. Variety in prior diagnoses would be consistent with a seizure-like disorder, here specifically implicating an imbalance in functioning between limbic and frontal lobe systems. Clinical tests for the latter were prevailingly indicative of dysfunctioning. A detailed clinical analysis of the violent acts within their context suggests behaviors are analogous to certain limbic system mechanisms, especially the kindling phenomenon.

An interdisciplinary approach to the diagnosis and management of a complex case of postencephalitic behavioral disorder

Postencephalitic behavioral syndrome secondary to measles is an almost extinct condition in Western culture. The present paper describes the clinical state of a 13-year-old pubertal female who presented nine years after the original acute febrile illness. In addition, an innovative behavioral approach to treatment of intractable seizures and aggressive behavior is described.

Interictal behavioral changes in epilepsy

Common behavioral alterations associated with epilepsy include increased interest in philosophical and religious concerns, increased and extensive writing of a cosmic or philosophical nature, changes in sexual behavior, and aggressiveness. Psychological stress, the effects of anticonvulsant therapy, and the actual occurrence of seizures or convulsions can be ruled out as possible causes of the syndrome. It is speculated that these behavioral alterations are the result of an intermittent spike focus in the temporal lobe that leads to an alteration in the responsiveness of the limbic system. Thus, there is a heightened emotional response to many stimuli as well as a decrease in sexual responsiveness. In an effort to discover the cause of the high incidence of sexual alterations, abnormalities in response to luteinizing hormone-releasing hormone (LHRH) were found in a group of patients with partial complex seizures, some of whom had no overt sexual dysfunction and had never received anticonvulsant therapy.