Personality correlates of sphenoidal EEG-foci in temporal lobe epilepsy

Religion, spirituality, and epilepsy

This review provides responses to four questions on epilepsy, religion, and spirituality. Firstly, have early religious beliefs and writings stigmatized and discriminated against epilepsy and if so, what has been done to correct this? We provide textual evidence suggesting an affirmative response. Secondly, which religious luminaries, gods, saints, and religious symbols have connections with epilepsy? We argue that the evidence to suggest that St Paul, Joan of Arc, the Prophet Mohammed, and others had epilepsy is weak and emphasizes the limitations of imposing contemporary neurological frameworks upon them. Furthermore, we discuss how different faith traditions identify Divine figures, as associated with epilepsy, and the use of religious symbols in healing. Thirdly, why is religiosity associated with having epilepsy? We review empirical studies focusing upon the epileptic personality, religiosity, mysticism, and religious conversion and find that, while some studies suggest that religious experience may be associated with epilepsy, this cannot be taken as proven. Fourthly, in what ways has religion been a force for good for those with epilepsy? We discuss the role of Christian social reform in caring for individuals with epilepsy and that of religion in coping with the condition. We conclude by arguing that the relationship between religion and epilepsy has been overstated in the academic literature.

The function of the anterior temporal lobe: a review of the empirical evidence

Recent work on the anterior temporal lobe (ATL) has lead to substantively different theoretical branches, of its putative functions, that have in some part developed independently of one another. The ATL has dense connectivity with a number of sensory modalities. This has resulted in empirical evidence that supports different functionality dependent upon the variables under investigation. The main bodies of evidence have implicated the ATL as a domain-general semantic hub, whilst other evidence points to a domain-specific role in social or 'person-related' processing. A third body of evidence suggests that the ATLs underlie processing of unique entities. Primarily, research of the ATL has been based on lesion studies and from clinical populations such as semantic dementia or temporal lobe epilepsy patients. Although important, this neuropsychological evidence has a number of confounds, therefore techniques such as functional neuroimaging on healthy participants and the relatively novel use of non-invasive brain stimulation may be more useful to isolate specific variables that can discriminate between these different theories concerning 'normal' function. This review focuses on these latter types of studies and considers the empirical evidence for each perspective. The overall literature is integrated in an attempt to formulate a unifying theory and the functional sub-regions within the ATL are explored. It is concluded that a holistic integration of the theories is feasible in that the ATLs could process domain-general semantic knowledge but with a bias towards social information or stimuli that is personally relevant. Thus, it may be the importance of social/emotional information that gives it priority of processing in the ATL not an inherent property of the structure itself.

On the psychopathology of unilateral temporal lobe epilepsy

Personality adjustment of patients with unilateral temporal lobe epilepsy (TLE) was investigated in the light of special characteristics of the epilepsy process, psychosocial stressors, and the cognitive status of the patients. Thirty-seven patients with medically intractable unilateral temporal lobe epilepsy (16-55 years of age; 20 right temporal and 17 left temporal foci) were examined with standardized personality inventories (FPI, STAI, IPC, TSK) supplemented by a rating scale evaluated by the neuropsychologist (GEWLE). Patients with left temporal lobe epilepsy were characterized by increased emotional dependency, less externally judged composedness, increased depressive drive and mood, increased nervousness, increased search for information and exchange of disease experience, and greater tendency to persevere (P < 0.05). Cognitive status and psychosocial status did not significantly differ. The evaluation of personality adjustment contributes to the lateralization of the epileptogenic focus and reveals interesting patterns in the preoperative diagnostic puzzle, and in addition provides a strategy to individualize psychotherapeutic strategies.

The psychiatric comorbidity of epilepsy

Several studies have assessed the prevalence of psychiatric disorders in epilepsy. They are characterized by considerable heterogeneity, because of differences in the population setting and type of study. A non-systematic review of the literature allows us to draw some useful, although not definite, conclusions. Six per cent of people with epilepsy in the general population appear to suffer from a psychiatric disorder, while this rises to 10-20% in populations with temporal lobe and/or refractory epilepsy. Mood disorders are the most common culprit (24-74%), particularly depression (30%), followed by anxiety disorders (10-25%), psychoses (2-7%) and personality disorders (1-2%). This comorbidity appears to be related to endogenous and exogenous (including iatrogenic) factors and to the severity and chronicity of epilepsy. Conditions such as schizophrenia-like psychosis of epilepsy and interictal dysphoric disorder are represented only in epilepsy. Adequate recognition and treatment of psychiatric conditions in epilepsy is essential for patient management because of their considerable burden in morbidity and quality of life.

[Interictal personality syndrome in non-dominant temporal lobe epilepsy: case report]

The syndrome of interictal personality in non-dominant temporal lobe epilepsy consists of hyposexuality, hyperreligiosity, humorlessness and hypergraphia. Its notification, in 1974, was followed by an extensive search for these traits in broad epileptic populations. Nevertheless, these statistical studies failed to match this syndrome in general temporal lobe epileptics, and its existence became then target of doubt. We report the case of a 35 year-old man presenting partial complex epilepsy, whose singularity lies in his sophisticated drawing abilities. The large amount of buildings and houses he paints expresses his hypergraphia. He also presents hyposexuality and hyperreligiosity. MRI shows right mesial temporal sclerosis. Temporal hyperconnection, caused by a basal temporal irritative focus, is the most probable pathophysiological mechanism. Epileptic fits can be controlled in the majority of cases. However, behavioural symptoms usually do not respond to pharmacological approach or psychotherapy.

Epilepsy and behavior: a brief history

Behavioral changes-both real and imagined-have formed a halo around epilepsy since antiquity. The myth of epilepsy as a curse has been largely vanquished in modern cultures, but the disorder remains a social stigma for many patients. In ancient Rome people with epilepsy were avoided for fear of contagion, in the Middle Ages they were hunted as witches, and in the first half of our century they were labeled deviants and their marriage and reproduction were restricted by eugenistic medical doctors. Religious conversion experiences can occur in temporal relationship to changes in seizure frequency. Many religious leaders may have had epilepsy. However, changes in religious sentiment are not characteristic of epilepsy patients. Recognized since the late 19th century, postictal psychosis has stimulated theories regarding the mechanism of mania and psychosis. Understanding the pathophysiology of behavioral changes in epilepsy may offer insight into the psychopathology of other diseases.

Depression in epilepsy: etiology, phenomenology, and treatment

A history of depression or depressive symptomatology has been reported in up to two-thirds of patients with medically intractable epilepsy, whereas community studies have demonstrated affective disorder only in a quarter of these patients. Depression has been reported peri- and interictally. However, differentiation may be difficult in patients with frequent seizures. Most authors have found no correlation between depression and epilepsy variables. However, complex partial seizures, especially of temporal lobe origin, appear to be etiologic factors, particularly in men with left-sided foci. Depression is also more common in patients treated with polytherapy especially with barbiturates, phenytoin, and vigabatrin. Depression has also been described de novo after temporal lobectomy. Psychosocial factors also play a part, but underlying risk factors (e.g., genetic, endocrine and metabolic) may explain the increased rates of depression in people with epilepsy compared to those with other neurologic and chronic medical conditions. The depression appears to be endogenous. Patients tend to exhibit fewer neurotic traits and more psychotic symptoms such as paranoia, delusions, and persecutory auditory hallucinations. Treatment approaches include psychotherapy, rationalization of antiepileptic drug medication, antidepressant treatment, and ECT. The tricyclic and related antidepressants appear to be epileptogenic, especially in people at high risk (personal or family history of seizures, abnormal pretreatment EEG, brain damage, alcohol or substance abuse/withdrawal and concurrent use of CNS-active medication). Seizures tend to occur early in treatment or after dose increments, especially if rapidly titrated. There is little evidence that the newer antidepressants, e.g., selective serotonin reuptake inhibitors, moclobemide, venlafaxine, or nefazodone are more epileptogenic than placebo.

Behavioral, psychotic, and anxiety disorders in epilepsy: etiology, clinical features, and therapeutic implications

This chapter deals with some aspects of psychiatric disturbances in people with epilepsy. Because depression and its treatment are extensively described later in this issue, they are not discussed here. The same pertains to forced normalization.

Enhancement of basal and pentylenetetrazol (PTZ)-stimulated dopamine release in the brain of freely moving rats by PTZ-induced kindling

The effects of pentylenetetrazol (PTZ)-induced kindling on the activity of mesocortical, mesoaccumbens, and nigrostriatal dopaminergic neurons was investigated with the transversal microdialysis technique in freely moving rats. Four days after the last chronic administration of PTZ, the basal extracellular concentrations of dopamine in the prefrontal cortex, nucleus accumbens, and striatum of kindled rats were significantly increased (+76, +36, +49%, respectively) relative to those of animals chronically treated with saline. Moreover, dopamine output was markedly more sensitive to the effect of a challenge injection of PTZ (20 mg/kg ip) in the prefrontal cortex (+93 vs. +50%, relative to basal values), the nucleus accumbens (+36 vs. +4%), and the striatum (+50 vs. + 35%) of kindled rats relative to that in the control animals. Because kindled rats and their controls are habituated to handling, the neurochemical mechanisms that underlie the effects of chemical kindling on the sensitivity of dopaminergic neurons to PTZ were investigated by comparing the effects of an acute administration of PTZ (20 mg/kg ip) between naive and handling-habituated animals. The sensitivity of dopamine output to PTZ in naive rats was markedly greater than that in handling-habituated animals for the prefrontal cortex (+83 vs. +50%) and nucleus accumbens (+35 vs. +4%), but not for the striatum (+35 vs. +32%). These results indicate that PTZ kindling enhances the basal activity and the sensitivity to PTZ of dopamine neurons in rat brain and suggest that mesocortical, mesoaccumbens, and nigrostriatal dopaminergic neurons contribute to the central alterations associated with experimental epilepsy.

Learned helplessness, attributional style, and depression in epilepsy. Bozeman Epilepsy Surgery Consortium

PURPOSE

We wished to examine the relevance of the theory of learned helplessness in general, and attributional style in particular, to the understanding of depression among patients with epilepsy.

METHODS

Patients with lateralized temporal lobe epilepsy (TLE) (right = 73, left = 70) were administered two self-report depression inventories [Beck Depression Inventory (BDI), Center for Epidemiological Studies-Depression scale (CES-D)]. Depression scores were examined in relation to a key component of the revised theory of learned helplessness (attributional style) using the Optimism/Pessimism Scale.

RESULTS

Attributional style was significantly associated with increased self-reported depression and remained significant when the effects of several confounding variables were controlled [age, age at onset, laterality of TLE, sex, and method variance].

CONCLUSIONS

The results indicate that the concept of learned helplessness in general, and attributional style in particular, are related to the genesis of depression in epilepsy. Because they are known to be related to depression in the general population, and because specific techniques for intervention and prevention are available, greater consideration of learned helplessness and attributional style in the genesis of depression in epilepsy may be worthwhile.

The role of dopamine in epilepsy

The clinical benefits of dopamine agonists in the management of epilepsy can be traced back over a century, whilst the introduction of neuroleptics into psychiatry practice 40 years ago witnessed the emergence of fits as a side effect of dopamine receptor blockade. Epidemiologists noticed a reciprocal relationship between the supposed dopaminergic overactivity syndrome of schizophrenia and epilepsy, which came to be regarded as a dopamine underactivity condition. Early pharmacological studies of epilepsy employed nonselective drugs, that often did not permit dopamine's antiepileptic action to be clearly dissociated from that of other monoamines. Likewise, the biochemical search for genetic abnormalities in brain dopamine function, as predeterminants of spontaneous epilepsy, proved largely inconclusive. The discovery of multiple dopamine receptor families (D1 and D2), mediating opposing influences on neuronal excitability, heralded a new era of dopamine-epilepsy research. The traditional anticonvulsant action of dopamine was attributed to D2 receptor stimulation in the forebrain, while the advent of selective D1 agonists with proconvulsant properties revealed for the first time that dopamine could also lower the seizure threshold from the midbrain. Whilst there is no immediate prospect of developing D2 agonists or D1 antagonists as clinically useful antiepileptics, there is a growing awareness that seizures might be precipitated as a consequence of treating other neurological disorders with D2 antagonists (schizophrenia) or D1 agonists (parkinsonism).

Interictal aggression in epilepsy: the Buss-Durkee Hostility Inventory

Adult patients with left, right, or bilateral temporal lobe epilepsy or absence epilepsy, and normal controls completed the Buss-Durkee Hostility Inventory (BDHI), a standardized questionnaire of aggressive tendencies. Patients with left temporal lobe seizure foci scores higher on the Suspicion scale than did other patients or controls (p < 0.05). Factor analysis scale scores identified three factors: hostile feelings, covert aggression, and overt aggression. The groups differed on their pattern of factor scores (p < 0.01): patients with left temporal lobe epilepsy scored higher than other groups on hostile feelings, normal controls scored higher on Covert aggression, and bitemporal patients scores higher on Overt aggression. Patients with absence seizures did not differ from controls. Lateralization of the seizure focus in patients with temporal lobe epilepsy may alter expression of aggressive behavior.

A clinical study of hypergraphia in epilepsy

Fifteen patients with epilepsy and hypergraphia were compared with 32 patients with epilepsy but without hypergraphia. The number of previous psychiatric episodes, the number of Washington Psychosocial Seizure Inventory (WPSI) items indicating emotional maladjustment, and the number of CT scan abnormalities were significantly greater in the hypergraphic patients than in the non-hypergraphic patients. Cognitive performance, EEG laterality and the scores of WPSI items related to the psychological stress of seizures did not differ significantly between the two groups. Hypergraphia reflects changes in emotional responsiveness secondary to organic temporal lobe lesions.

Carbamazepine offers no psychotropic advantage over phenytoin in adult epileptic subjects

We compared 19 men on carbamazepine (CBZ) monotherapy with 19 men on phenytoin (PHT) monotherapy, all of whom had standard therapeutic levels. The two groups were matched for age, sex, education, premorbid predicted IQ, seizure frequency, duration, number, type and aetiology, weekly ethanol consumption and psychiatric history. The two groups did not differ statistically on self- and reliable-informant rated personality inventories, word recognition, face recognition, confrontation naming, finger oscillation or trailmaking series completion times. These data fail to support a behavioural and cognitive advantage of CBZ over PHT in adult epileptics.

Episodic psychic symptoms in the general population

The frequency of some episodic psychic symptoms (dysmnesic, perceptual, and experiential) was determined in a 2,500-subject general population sample. Correlations with some risk factors eventually associated with nervous system dysfunctions (seizure history, head injury, car accident, hospitalization, febrile illness, and birth injury) were calculated. Subjects with one or several risk factors were more likely to report episodic psychic phenomena in daily life. Significant correlations of episodic psychic phenomena with sleep disorders, headache, allergies, and a history of learning disabilities were observed. We propose that some subclinical dysfunctions can be associated with the appearance of episodic psychic phenomena in otherwise normal subjects.

Prior head injury accounts for the heterogeneity of the alcohol-epilepsy relationship

Fifty-five adult male patients with alcoholism and seizures were divided into three groups. In group I, all seizures were consistently produced by alcohol withdrawal (N = 16); in group II, some seizures were clearly precipitated by alcohol withdrawal and others were not (n = 18); and in group III none of the seizures had a consistent relationship with drinking (N = 21). The three groups were compared for age, frequency of seizures, compliance, Bear-Fedio and Boston-Naming scores, those for memory of words and faces, and finger-tapping scores, and neuropsychological impairment ratings as well as EEG background frequencies. The incidence of severe head injury preceding the onset of seizure disorder was significantly higher in groups II and III. This was further supported by a greater prevalence of asymmetric alpha rhythm, abnormal CT scans and multiple seizure types in those two groups. These data indicate that a prior head injury is a major variable accounting for the heterogeneity of the alcohol-epilepsy relationship.

Interictal depression in epilepsy

The relation between depression and epilepsy was evaluated in 96 epileptic out-patients. We found that 50% of epileptic patients fulfilled the DSM-IIIR criteria for depression. The Hamilton Rating Scale for Depression, the Beck Self Depression Inventory and the Zung Anxiety Scale were also used in all patients. The patients with partial seizures with complex semiology (CPS) were more depressed than the patients with primary generalized epilepsy and with partial seizures with elementary semiology. A significant increase in the level of anxiety was also found in the group with CPS compared to the other two groups. No correlations were noted between severity of depression and duration of epilepsy, seizure frequency, socio-economic status, education, and family history of depressive illness. No relationship was observed between anticonvulsant drug levels and depression. We failed to confirm an association between side of epileptic lesion and severity of depression. We suggest that depression in epileptic patients does not represent a psychological reaction to a particular cognitive or physical impairment, but is in some way related to the type of epilepsy.

Psychopathology of people with mental handicap and epilepsy. III: Personality disorder

A group of 75 mildly to moderately mentally handicapped people with epilepsy, resident in both a hospital and the community, were studied together with an individually matched control group of non-epileptic patients. Their carers were interviewed to gather information for two observer-rated personality questionnaires, the Standardised Assessment of Personality (SAP) and the T-L Personality Behaviour Inventory. The two groups were compared with respect to the prevalence rates of various personalities. An abnormal personality score according to the SAP schedule was reported in 26% (n = 39) of the cohort, of which 28 (18.6% of the cohort) were personality disorders. A diagnosis of SAP abnormal personality was made in 46% of the in-patients and 6.5% of the community-based population. Of the cohort, 15% had an abnormal personality score according to the T-L schedule. No statistically significant difference emerged between the epileptic and the non-epileptic groups in the prevalence of either the SAP or T-L personality.

Effects of chronic treatment with haloperidol and methamphetamine on hippocampal kindled seizures in the cat

We assessed the effects of chronic treatment with haloperidol (0.5-2 mg/kg/day, p.o., 17 days) and methamphetamine (1-2 mg/kg/day, p.o., 17 days; 4 mg/kg/day, p.o. 9 days) on hippocampal kindled seizures using a kindling procedure with low-frequency (about 3 Hz) electrical stimulation in cats. The number of stimulating pulses required to trigger epileptic afterdischarge (pulse-number threshold, PNT) was considered an indicator of seizure threshold. Haloperidol, 0.5 and 1.0 mg/kg, reduced the duration of epileptic afterdischarge (afterdischarge duration, ADD) without affecting PNT, and 2.0 mg/kg strongly reduced PNT and ADD. Methamphetamine, 2.0 mg/kg, reduced PNT and ADD, and 4.0 mg/kg preferentially reduced PNT. The effects of the two drugs on hippocampal kindled seizures were found to be partially opposite to those on amygdala kindled seizures, suggesting the different response of these limbic structures to dopamine receptor manipulation.

Psychopathology and limbic epilepsy: relationship to seizure variables and neuropsychological function

Correlations were sought among psychopathologic, neuropsychological, and seizure variables in 21 patients with limbic epilepsy. Observer-based assessments, such as the Bear-Fedio Inventory, and self-report assessments of psychopathology were used. Self-reported psychotic experiences were associated with increased seizure frequency. Increased religiosity was noted in patients whose epileptic focus included the left side. Increased neuropsychological impairment was associated with several measures of psychopathology, including those related to thought disorder, psychoticism, and affective disturbance.

Personality characteristics and epilepsy

Patients with a long history of temporal lobe epilepsy or primary generalized epilepsy entered a questionnaire study of personality characteristics, based on a modification of the Bear-Fedio inventory for temporal lobe behavioural syndrome. Psoriasis patients and healthy volunteers served as controls. Four clinical meaningful dimensions of included personality traits were identified: ixoide, ideational, obsessive-compulsive and affective features. Analyses based on the Rasch model approved of all dimensions except for affective features. The epilepsy group obtained the highest scores on all 3 dimensions, healthy volunteers the lowest, while the psoriasis group repeatedly held an intermediate position in all sets of assessment (subjects, interviewers and relatives). A logistic regression analysis showed ixoide features being most important when the entire epilepsy group was compared with other study groups, while the dimension ideational features was significant when the temporal lobe epilepsy group was entered as target group and opposed to primary generalized epilepsy. The intermediate position of the psoriasis group, however, suggests that in addition to the presence of a cerebral dysfunction in the epilepsy group, the mere presence of a chronic disorder with potential social stigmatization influences personality.

Ego functions in epilepsy

Two groups of epilepsy patients (28 patients with temporal lobe epilepsy and 15 patients with primary generalized epilepsy) entered a study of personality traits related to epilepsy, based on a modification of Bellak's semistructured interview for assessment of ego strength. Two groups of subjects served as controls: 15 patients with a non-neurological but relapsing disorder, psoriasis, and 15 healthy volunteers. Compared with the group of healthy volunteers, a decreased adaptive level of ego functioning was found in the epilepsy groups, regardless of seizure types and EEG findings, and, to a lesser extent, compared with the psoriasis group. Areas of ego functioning most affected were "reality testing", "cognitive functioning", "integrative functioning" and "regulation and control of drives". Patients with more than one type of seizure were the most affected, as were patients who were younger than 15 years when the disease began. The number of anticonvulsants administered did not influence the results. No difference on adaptive level of ego functioning was found between the group with primary generalized epilepsy and the group with temporal lobe epilepsy. Similarly, the temporal lobe epilepsy group with predominantly right-sided and left-sided EEG changes, respectively, showed similar adaptive levels of ego functioning.

Complex partial status and schizophrenia

Three cases of complex partial status which were diagnosed as psychotic episodes are presented. The scans of two of these cases show structural abnormalities in the left temporal lobe. It is proposed that there are similar neurophysiological mechanisms in primary schizophrenia and in the perceptual, affective and cognitive phenomena apparent is some complex and psychic partial seizures. The hippocampal-amygdaline system plays a central role in both cases.

Effects of chronic lithium treatment on limbic seizure generation in the cat

The effect of chronic lithium administration (2.2-8.7 mEq/kg/day, 17 days) to the cat on seizure initiation in the amygdala and hippocampus was assessed by the low-frequency kindling technique. Lithium 4.3 mEq/kg/day PO, producing a serum lithium level between 1.2 and 1.6 mEq/l, caused an elevation of the amygdala seizure threshold on treatment days 5-9. In contrast, the same dosage caused a transient reduction of the hippocampus seizure threshold on treatment days 13-17 and on withdrawal days 21-25. Lithium 2.2 mEq/kg/day PO caused no significant effect on the parameters of the two types of seizure. Lithium 8.7 mEq/kg/day PO caused severe behavioral changes and did not permit chronic treatment. These results indicate that the effect of chronic lithium treatment on limbic seizures is dependent on the location of epileptic focus.

Personality disorders and epilepsy

The relationship between epilepsy and personality disorder is viewed. The historical links are discussed, and it is pointed out that the position has moved from that of assuming that everybody with epilepsy will undergo personality change, to noting in particular changes that may be associated with temporal lobe, especially limbic system, abnormalities. The Geschwind syndrome is briefly described, and the association between aggression and epilepsy explored. It is concluded that some aspects of personality may improve following temporal lobectomy, especially if seizures also improve.

Psychopathology in epilepsy: prevalence, phenomenology and management

Epilepsy is associated with interictal behavioral disturbances. The pattern of specific psychopathology differs from that of other chronic diseases because of the higher incidence of psychosis and characterological disorders. Approximately 7 percent of epileptics develop a chronic atypical psychosis with paranoid and affective features, and this may be more common in patients with a definite temporal lobe focus. Brief psychotic episodes occur and are more directly related to cerebral dysrhythmia. A subgroup of epileptics develop specific personality traits, aggressive behaviors under certain circumstances, and hyposexuality. Affective illness and suicide are also prevalent. There are special issues in the management of psychopathology in the setting of epilepsy such as the relative seizure threshold lowering effects of psychotropic drugs and the behavioral effects of altering the seizure control. This article discusses both diagnostic and management aspects of the interictal psychopathology of epilepsy.

Ictal and enduring interictal disturbances in emotional behaviour in an animal model of temporal lobe epilepsy

Unilateral microinjections of kainic acid (4.7 nmol) were made into the dorsal hippocampus of 17 unanesthetized freely moving cats. These injections provoked an acute period of intense seizure activity (first 48-72 h) which in 10 cats was followed by a chronic period of recurrent spontaneous complex partial seizures persisting for as long as the cats were studied (up to 4 months). During the chronic epileptic period 8 of these 10 cats demonstrated both ictal and interictal emotional behaviour disturbances. The ictal events included behaviour similar to a 'defensive rage' reaction. Interictally, each of the cats demonstrated an emotional lability. That is, although they behaved in a normal manner if handled affectionately, any mild provocation triggered an explosive defensive rage reaction. As well, the thresholds for electrical brain stimulation induced defensive rage were lowered. That the interictal emotional behaviour disturbances were related to the presence of an active epileptogenic process was suggested by the finding that during periods when no spontaneous seizures were observed for several days, the cats reverted to a less emotionally reactive state and the thresholds for stimulation-induced defence reactions returned to baseline. The results indicate that epileptogenic lesions of the temporal lobe alone can induce an enduring disturbance of emotional behaviour. They support the view that emotional disturbances in patients with epilepsy may sometimes result from pathophysiological mechanisms related to the epileptogenic process, and further suggest that such emotional disturbances might be reversed or prevented if the epileptic seizures could be controlled.

Epilepsy and verbosity

Stories were elicited from 29 epileptic patients with generalized, simple partial, and complex partial seizures with bilateral, right, or left foci, and from 32 persons in two control groups. Four older epileptic patients with long histories of left complex partial seizures were verbose. Their stories involved trivial and subjective details, consistent with circumstantiality and suggesting the substrate for a hallucinatory syndrome.

Personality and neuropsychological aspects of temporal lobe epileptics and schizophrenics

The present study was designed to ascertain and explore whether distinct personality profiles and neuropsychological features characterized temporal lobe epilepsy (TLE) vs. schizophrenic patients (Sc). The subjects were 20 epileptics and 19 schizophrenics matched with an overall IQ. They underwent various personality and neuropsychological tests. These results showed that the personality of the left-TLE patients tended to be more sensitive, aggressive, hostile and emotionally labile than the right-TLE and Sc patients. Finally, the Sc patients showed poor performance in verbal and nonverbal delayed tasks, especially on the right visual hemifield ones. These results suggested that they have the frontal lobe dysfunction, especially of the left hemisphere.

The value of nasopharyngeal recording in psychiatric patients

The utility of nasopharyngeal (NP) recording in psychiatry is controversial. To assess its value, 302 NP recordings from patients with psychiatric illnesses were reviewed. Among the 81 patients whose electroencephalograms (EEGs) demonstrated spikes or sharp waves, 10 patients (12%) were found to have epileptic foci at the mesiobasal temporal region recorded exclusively by NP leads. However, all of these recordings showed additional independent epileptic foci detected by scalp electrodes. Five patients (6%) had epileptic discharges simultaneously recorded from NP and scalp electrodes. No recording showed all epileptic discharges to be exclusively recorded by NP leads. These findings suggest that although NP recording may not be absolutely required to determine if an EEG contains epileptiform discharges, in a psychiatric population, it may be useful to detect additional epileptic foci at the mesiobasal temporal region.

Neurobiology of behavior: anatomic and physiological implications related to epilepsy

Controversy exists concerning whether epileptic seizures can produce enduring alterations in neuronal function that cause interictal behavioral disturbances. Although arguments favoring the occurrence of epilepsy-induced disorders of behavior must not be presented in a way that adds to the stigmata associated with epilepsy, it is not in the best interest of epileptic patients to deny this possible relationship and overlook an opportunity to prevent or treat a major cause of disability. There is evidence to suggest that psychosocial factors cannot account for all the behavioral problems suffered by patients with epilepsy. Behavioral disturbances ascribed to antiepileptic drugs and specific structural lesions may also be due, in part, to epileptogenic mechanisms. Some interictal behavioral disturbances may actually reflect unrecognized ictal events. Most importantly, data obtained from clinical research and animal investigations suggest testable hypotheses of how recurrent epileptic seizures can alter neuronal function in ways that would predispose to specific disruptive interictal behaviors, such as aggression, depression and schizophrenia.

Interictal behavioral features of patients with epilepsy

Three questions are dealt with in this paper. (1) Do patients with epilepsy differ behaviorally from normal control groups and from persons with other medical and neurological conditions with respect to emotional adjustment, and if so, in what ways? (2) Are patients with temporal lobe epilepsy different emotionally or behaviorally from patients with other types of epilepsy? (3) To what degree does underlying brain dysfunction create a substrate for abnormal and maladaptive behavior? A review of the literature reveals the following. Persons with epilepsy demonstrate more emotional and psychiatric problems than normal individuals and more difficulties than other patient groups having nonneurological disorders, but have about the same incidence of these problems as persons with other neurological disorders. Increased emotional and psychiatric problems are not found among patients with temporal lobe epilepsy in comparison to patients with other types of epilepsy, although there are some behavioral peculiarities which appear in a small proportion of these patients. There is a mild tendency for impairment on neuropsychological tests to be associated with emotional and psychiatric problems in epilepsy.

Autonomic responsiveness to affective visual stimulation in temporal lobe epilepsy

Patients with temporal lobe epilepsy (TLE) have been posited by some to manifest a syndrome of interictal personality and behavioral change. Furthermore, this syndrome has been attributed to an underlying mechanism--enhanced affective responsiveness. The purpose of this investigation was to determine whether patients with TLE manifest increased emotional responsiveness relative to appropriate controls. Patients with TLE (n = 23) were compared with non-TLE (n = 7) and healthy controls (n = 16) as to their autonomic nervous system responsiveness to an emotionally stressing film. No differences were found among the groups. These results are related to the larger literature concerning epilepsy and psychopathology.

Hypergraphia in epilepsy: is there a specificity to temporal lobe epilepsy?

The purpose of this investigation was to determine the specificity of hypergraphia to temporal lobe epilepsy using the paradigm developed by Sachdev and Waxman (1981). One hundred and thirty-eight patients were sent a standard stimulus letter and the response rates were examined for the patient groups with temporal lobe epilepsy (N = 80), and without (N = 31), and mixed seizure types (N = 13). For those patients who responded, additional analyses involved the number of words per response and the presence/absence of any qualitative indices of the postulated interictal behavioural syndrome of temporal lobe epilepsy. The results were interpreted in the light of the contemporary definitions of hypergraphia and were related to the larger literature concerned with personality and behavioural change in temporal lobe epilepsy.