Incidence

Fifty-one (2 ) out of 2905 patients with epilepsy treated at Kansai Regional Epilepsy Center experienced postictal psychoses that were not artificially induced (Table 9.1). It is difficult to compare our data with previous studies, as they are either multiple case reports (Lancman et al., 1994 Levin, 1952 Logsdail and Toone, 1988 Savard et al., 1991 Umbricht et al., 1995) or based on observations during Table 9.1. Incidence of epileptic psychosis Table 9.1. Incidence of epileptic psychosis *...

Postoperative de novo manic depressive illness

Hill et al. (1957) were one of the first to recognize that depression could occur after a temporal lobectomy. In a series evaluated by Taylor (1972), five patients committed suicide. In another follow-up study, Taylor and Marsh (1977) reported that the mortality rate during the first 2 years postoperatively was twice as high as that in any subsequent 2-year period. Further, in a Danish series investigated by Jensen and Larsen (1979), all suicide attempts occurred within the first postoperative...

Association with temporal lobe epilepsy

Idiopathic localization-related epilepsy Symptomatic localization-related epilepsy Symptomatic cryptogenic generalized epilepsy a Six patients with both postictal and interictal psychoses were excluded. b Chi-square 5.14, statistically significant difference (p< 0.05). Table 9.6. Laterality and localization of the laboratory findings Table 9.6. Laterality and localization of the laboratory findings Patients with both temporal and extra-temporal pathology were excluded. b Statistically...

Cognitive side effects of antiepileptic drugs

Treament of seizures requires antiepileptic drug (AED) treatment for the large majority of patients and may be accompanied by unwanted effects on cognitive function. Although the magnitude of such 'cognitive side effects' is generally considered to be mild to moderate for most of the AEDs, their impact may be substan tial in some patients when critical functions are involved such as learning in children (Aldenkamp et al., 1995 ) or driving capacities in adults (often requiring milliseconds...

Affective disorders and anxiety

As is the case for psychoses, it is also true for the affective disorders that the usual psychiatric diagnostic categories do not offer adequate classification for epilepsy patients. Typical constellations of symptoms allowing the diagnosis of a 'major' depressive episode are rare, dysthymic or 'organic' depressive states rather frequent. Blumer and Altshuler (1997) have attempted to introduce a useful classification category of affective disorders in patients with TLE, which they call...

Introduction

1 Institute of Neurology, London, UK 2 Humboldt University, Berlin, Germany In 1997, Dr Pete Engel, President of the International League Against Epilepsy, invited us to establish a commission on psychobiology, and this book represents one of the achievements of the commission's work. The task of the commission was to explore the interface between epilepsy and behaviour disorders, from a biological and social point of view. To these ends a number of subcommissions were established, and their...

References

Arana, G.W., Goff, D.C., Freidman, H. et al. (1986). Does carbamazepine-induced reduction in haloperidol plasma levels worsen psychotic symptoms Am J Psychiatry, 143, 658-9. Blumer, D. (1997). Antidepressant and double antidepressant treatment for the affective disorder of epilepsy. J Clin Psychiatry, 58, 3-11. Bremner, J.D. (1995). A double blind comparison of ORG 3770, amitriptyline and placebo in major depression. J Clin Psychiatry, 56, 519-26. Burley, D.M. (1977). A brief note on the...

Transitory cognitive impairment

A number of papers describing this phenomenon have been published by Binnie and coworkers (Aarts et al., 1984 Marston et al., 1993). The basic concept is that an epileptiform discharge that does not appear, on simple observation, to be manifesting as a seizure, may nevertheless cause a transitory impairment of cognitive function. It has been shown that discharges on the left side may impair language function and on the right side may impair visuo-spatial skills. The quality of the impairment is...

Conclusion

Research into the neurobiological basis of aggression is still hampered by the difficulty in defining phenomenological and nosological homogeneous study groups. Nevertheless, it is important to develop a more precise understanding of the complex interplay of social, psychological and neurobiological factors all contributing to the aggressive and violent behaviour. Aggression in epilepsy is rare. However, if it occurs it imposes an immense burden on the patient, relatives and caregivers....

Movement control structure

The neodissociation account of dissociative behaviours. (Adapted from Kirsch and Lynn, Lynn, 1995). Although one part of the fractionated executive continues to function as normal during hypnosis, the second part is concealed from awareness by the formation of an amnesic barrier. This part of the ego can exert behavioural control in the usual fashion but such control is prevented from representing itself in consciousness by the amnesia (see Figure 13.1). Hypnotic behaviours result...

Dissociative mechanisms of nonepileptic seizures

If one assumes that nonepileptic seizures are a dissociative phenomenon, what mechanisms might be involved in the generation and maintenance of these events Current theorizing in this domain is still very much dominated by nineteenth century ideas concerning the mechanisms underlying so-called 'hysterical'5 phenomena. Indeed, the term dissociation originates in the work of Pierre Janet who proposed one of the earliest systematic accounts of the psychological mechanisms underlying hysteria....

Acknowledgements

For assistance with recruitment of patients we gratefully acknowledge the assistance of Prof. S. Shorvon, Prof. J. Duncan, Dr J.W.A. Sander, Dr D. Fish and Dr S. Smith. Thanks also to Dr M. O'Donoghue who provided training in the use of the National Hospital Seizure Severity Scale. An earlier version of this paper was presented at the EuroQol Plenary meeting in Hannover, 1-3 October 1998. Baker, G. (1995). Health-related quality of life issues optimizing patient outcomes. Neurology, 45 (Suppl....

Positive psychotropic effects of AEDs in epilepsy patients

Antiepileptic drugs are increasingly being marketed for a broad spectrum of psychiatric disorders. Unfortunately we cannot extrapolate from studies performed with primary psychiatric patients that there are positive psychotropic effects when these drugs are prescribed for epilepsy patients. Most studies in psychiatry are done with patients suffering from bipolar disorder, and this is a relatively uncommon diagnosis in patients with epilepsy. As an example, the well-established mood-stabilizing...

Biochemical pathophysiology

Although there are various models of neurochemical disturbance underlying seizure genesis and also various models proposed to underlie PD, in both conditions aetiological disruptions of the GABA system have been proposed. It is well established that GABA exerts an inhibitory control on neuronal excitability by its rapid action on Cl channels. The mechanisms of several antiepilep-tic drugs, such as phenobarbitone, vigabatrin and benzodiazepines, involve enhancing GABAergic activity in various...

Case reports

A 28-year-old kimono shop manager had a 20-year history of paroxysmal fearful feelings of being left alone. At age 11, complex partial seizures began to follow these moments of fear. As his age advanced, his seizures increased in intensity as well as frequency, despite maximum drug therapy. At age 26, the first manifest postictal mental derangement occurred, after several bouts of complex partial seizures. One day after this cluster of seizures, he struck his father, the owner of the kimono...

Drug study subjects and methods

Patients attending a follow-up appointment at the outpatient epilepsy clinics at Queen Square were approached after their medical consultation. The patients recruited were about to start on one of the five antiepileptic drugs (vigabatrin, clob-azam, lamotrigine, gabapentin and topiramate) as add-on therapy. Those willing to take part, and who gave informed consent, were offered the choice of a telephone interview at home as an alternative to a face-to-face interview and most patients chose this...

Other psychotropic agents

Patients with epilepsy are prescribed a variety of other psychotropics, the main ones being benzodiazepines, either as hypnotics or anticonvulsants, and lithium, a mood stabilizer. Benzodiazepines should be used in caution in patients with epilepsy, the main problem being the potential for a paradoxical increase in seizures, or withdrawal seizures on stopping the prescription. Further, some of these drugs have a potential for the development of dependency. There appear to be differences between...

Classification of learning disorders

Learning disorders occurring during epilepsy can be classified into two categories state-dependent (potentially treatable and reversible) and permanent. The prevalence of state-dependent or permanent learning disorders is not satisfactorily known. Brain damage or stable brain dysfunction is mainly associated with permanent learning disorders. Epilepsy itself or the medication used to treat it may lead to state-dependent learning disorders. The picture is further complicated by associated mood...

Panic disorder

In both the ICD-10 and DSM-IV diagnostic classifications PD is considered as an anxiety disorder. Although these classificatory systems do not represent the last word in mechanistic understanding of behavioural disorders, it is clear from the inclusion of PD within the anxiety disorder neurotic disorder grouping that the general view is that PD has a psychological rather than a biological aetiology. However, whilst it is clear that the core subjective experience of PD is one of extreme fear,...

Possible anatomic substrates of some behavioural disturbances associated with epilepsy

The behavioural disturbances most associated with epilepsy include depression and other affective disorders and personality traits, schizophrenia, aggressivity and anxiety. The prevalence of affective disorders is higher among epileptic patients than the general population, or neurological patients with the same degree of disability (Mendez et al., 1986). No neurobiological mechanism has successfully explained this correlation between affective disorders and epilepsy. However, several...

Pathogenesis of the psychiatric disorders of epilepsy

Suicide in epilepsy appears to be caused by the interictal and sometimes by postictal psychopathology. Since the early reports by Gibbs 1951 , Landolt 1953 , and Hill 1953 , evidence has been increasing that the interictal psychopathology tends to emerge or to worsen upon improvement of the epilepsy as measured by seizure frequency and EEG abnormalities. There is persuasive evidence that the psychiatric disorders of epilepsy may result from the inhibitory activity that develops in reaction to...

Lucid interval recurrence and duration of postictal psychosis

Postictal psychosis has long been confused with the clouded consciousness observed following complex partial seizures. Recent studies, including ours, have proven that postictal psychosis cannot be reduced to a mere extension of postictal confusions. The primary argument in support of this is twofold 1 there is preserved orientation and memory seen during the episodes, and 2 lucid intervals occur between the end of the seizures and the start of postictal psychoses Kanemoto et al., 1996 Levin,...

Ability of the QOLAS and the EQ5D to detect change in HRQOL

The QOLAS asks patients to nominate the HRQOL topics of concern to them. They are able to both choose the items and, importantly, discuss them in their own language or idiom. The QOLAS therefore taps each patient's perceived change in their own HRQOL rather than objectively verifiable changes in status e.g. role social functioning. The EQ-5D, a generic instrument, might not have basic face validity for particular patient populations, and epilepsy in particular. Comparing our audit data with the...

Peripheral mechanisms

Since the vagus is a mixed nerve, VNS always comprises a portion of efferent stimulation which may alter peripheral functions. For instance, it may cause hoarseness as the most common adverse effect of VNS. As a matter of course, any changes concerning mood or epileptic seizures must be due to cerebral changes. However, from a theoretical point of view one has good reasons to expect that peripheral changes induced by efferent VNS may in turn result in cerebral changes relevant for the issues...

Epilepsy and behaviour disorders

Single case reports of behavioural and personality disorders in patients with severe brain lesions often appear dramatic. However, with respect to focal epilepsies, these reports nevertheless raise the question of whether there might be parallels in the behaviour when epilepsy affects the same brain regions. With the exception of rare cases of ictal aggression, postictal confusional states or psychosis Marsh and Krauss, 2000 , behaviour and personality disorders observed in patients with FLE...

Questions of indication and contraindication

Alongside obvious indications such as a marked anxiety, obsessive-compulsive or borderline disorder, we consider that the indication for a supplementary psychotherapy should always be examined in epilepsy patients when a an epilepsy treatment is difficult in itself, and particularly when b 'noncompliance' or c 'pharmacoresistance' are present. One particular impediment to recognizing the indication for psychotherapy is found in those underdiagnosed cases in which an epilepsy is accompanied by a...

Amygdala

Images Orf Post Ectal

The amygdala has been implicated in a number of important primal functions, including fear, aggression, learning, reproduction and appetitive drive. In contrast to the hippocampus, it consists of a number of loosely organized subnuclei with diverse neurons and cytoarchitecture, which have been divided into an olfactory group, a centromedial group and a basolateral group Gloor, 1997 Schwartzkroin and McIntyre, 1997 . The olfactory group has predominant reciprocal connections with the...

Electrophysiology

A variety of abnormal electrophysiological findings have been reported in groups of patients with PD in comparison with healthy control subjects. Patients with panic attacks have been reported to have an increased amount of paroxysmal EEG activity Hughes, 1996 , with this occurring up to four times more often than is the case in patients with a depressive illness. Temporal lobe abnormalities have been highlighted in brain electrical activity mapping BEAM studies in patients with panic attacks....

The biological significance of phenomenological similarities between PD and epilepsy

It has been reported that ictal fear occurs in between 5 and 15 of those with temporal lobe epilepsy. The experience may vary from mild uneasiness to intense feelings of panic and impending doom Devinsky and Vazquez, 1993 . Fear is a relatively common aura experience in patients with temporal lobe epilepsy, representing 10 of the experiences reported by Taylor and Lochery 1987 . Williams 1956 investigated emotional phenomena in 2000 patients with epilepsy and found that 100 of them reported an...

Interhemispheric limbic connections

Due to the enormous expansion of the human cerebral cortex in comparison with that of subprimate mammals, the limbic structures, with the exception of the ungulate gyrus, have moved far from the midline. Interhemispheric connections are necessarily increased in length and changed in trajectory by this major reorganization Wilson, 1995 . Three pathways exist for interhemispheric communication between limbic areas corpus callosum, anterior commissure and hippocampal commissure. The corpus...

Ictal behaviour in frontal lobe seizures positive and negative phenomena

Like others before us, we recently analysed seizure phenomena in patients with FLE by video-EEG monitoring. The main purpose was to get hints from seizures for differential diagnosis. On the other hand, seizures can be studied in terms of transient dysfunctions which are more or less localized and seizure semiology preserved functions, as well as impaired functions, can tell us something about the cerebral functional organization of cognition and consciousness. We studied 'positive phenomena'...

Nonepileptic attacks nonepileptic seizures

Most centres are reluctant to operate on patients with epileptic seizures which occur in association with nonepileptic attacks. Even if the epilepsy is cured by surgery, there is a high probability of the dissociative attacks continuing. Therefore, only after nonepileptic attacks are well treated by psychotherapeutic interventions should surgery be considered Henry and Drury, 1997 . Concerning postoperative nonepileptic attack disorders NEADs , there are some reports in early surveys on the...

Academic achievement and employment in frontal lobe epilepsy

From patients with frontal lesions, it is well known that they may show unimpaired cognitive functions but nevertheless fail on everyday demands of job and career because of behavioural problems, unsteadiness, concentration problems, increased susceptibility to interference and problems with timing and planning. Subjective data may not detect behavioural problems because patients with frontal lobe lesions have been reported to underestimate their impairments. With school achievement and...

Dissociation as nonintegrated mental modules or systems

This is probably the most widely used definition of dissociation and is reflected in the so-called dissociative disorders categories of current psychiatric taxonomies. According to DSM-IV, 'the essential feature of the dissociative disorders is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment' p. 477 American Psychiatric Association, 1994 . Dissociation in this sense reflects the original meaning of the term d sagr gation,...

Antipsychotic drugs

A classification of the antipsychotic drugs is given in Table 20.5 as with antide-pressant drugs, in recent years there have been several newer agents introduced into clinical practice. These essentially, with some exceptions, fall into the class of atypical antipsychotics. Table 20.6 gives a review of the receptor-binding profiles of a number of these agents. The classical neuroleptic drugs, such as chlorpromazine and haloperidol, antagonize dopamine D2 receptors. Essentially their clinical...

Positive psychotropic effects of antiepileptic drugs in psychiatric patients

The positive psychotropic properties of carbamazepine and valproate are well established. Both anticonvulsants are frequently used in psychiatric patients. Carbamazepine is indicated for the prophylaxis of bipolar disorder and the management of episodic dyscontrol, and valproate is particularly useful in the treatment of acute mania Walden et al., 1998 . The antidepressive effects of lamotrigine, which were suspected shortly after its introduction, have been confirmed in controlled studies of...

Temporal Gate hypothesis

We have proposed a possible mechanism to account for the above observations, which in deference to Ingvar 1984 we have called the Temporal Gate hypothesis Brown, 1999 . This may be summarized as follows 1. Certain neuropsychological functions of the frontal lobes come to maturity during and after puberty, the process being influenced by the neuroendocrine axis. 2. This maturation of functioning is also dependent on frontal lobe input from an intact temporo-limbic system. 3. If seizures of...

Types of QOL measure

There is no 'gold standard' for measuring QOL and the range of instruments available, or still undergoing development, is remarkable in terms of both quantity and heterogeneity. The range of categories of QOL health status measures has been comprehensively reviewed elsewhere Brooks, 1995 . In brief, generic instruments cover a broad range of QOL domains in a single instrument. Their chief advantage is in facilitating comparisons among different disease groups. Disease-specific instruments...

Contributors

Learning Disability Service Bedfordshire amp Luton Community NHS Trust University of Tennessee College of Medicine Department of Psychiatry 135 North Pauline Memphis TN38105, USA Cornwall Healthcare Trust Unit 10 Bodmin Business Park Harleigh Road Bodmin National Hospitals for Neurology and Neurosurgery Institute of Neurology Queen Square London WC1N 3BG, UK Clinical Psychiatry University of Milano Bicocca San Gerardo Hospital Via Donizetti 106 Mona, Italy Epilepsy Centre Bethel Epilepsy...

Psychopathological features

The most striking differences between interictal and postictal psychoses lay in the domain of psychopathological phenomenology Table 9.9 . In a series presented by Logsdail and Toone 1988 , only one of 14 patients had primary delusions or thought disorders 7 , whereas as many as nine exhibited a markedly abnormal mood 64 . Our previous study, comparing the psychopathological features of postictal psychoses with those of interictal psychoses, supported their data. The first-rank symptoms of...

Treatment

Treatment for postictal psychosis should be directed at two different stages. First, once an episode of postictal psychosis appears, a direct shortening or alleviation of postictal psychosis should be attempted. While Kanner et al. 1996 recommend dopamine blockers, Lancman et al. 1994 advise the use of benzodiazepines and sedation with chloral hydrate. However, this difference in opinion is more apparent than real. In a typical case, postictal psychosis begins with an initial hypomanic state,...

Postoperative psychoses

One question is, whether or not there are typical de novo psychoses induced by ES. According to one position, postoperative psychoses primarily occur as so-called de novo postictal psychoses Savard et al., 1998 in patients with persistent seizures, and thus are only indirectly connected with the surgical event. Another position is that surgery only has the function of a trigger that releases a manifest psychosis, which was already latent and might have found its preoperative expression in...

Role of the interictal and periictal psychopathology in suicide

The premodern psychiatrists who established the basis for our modern classification of mental disorders noted that specific mental changes were associated with epilepsy. They had the advantage of observing institutionalized patients with chronic epilepsy over prolonged periods and were familiar with the characteristic intermittent and pleomorphic changes that have eluded the modern cross-sectional psychological assessment of patients with epilepsy. Modern assessments are usually carried out...

New antidepressant drugs and seizures

All of the SSRIs have been associated with seizures in clinical practice, although there is some evidence which suggests that they may have less seizure potential than the earlier agents. Krijzer et al. 1984 , used freely moving rats implanted with subcortical electrodes. Almost all of the antidepressants tested caused epileptogenic EEG changes mianserin was the most potent. However, fluvoxamine caused only minimal effects. None of the newer agents have been tested in such models and clinical...

Mood improvements by VNS in epilepsy patients

Reports from the early randomized controlled trials on VNS for epilepsy treatment EO3, EO5 suggested improved quality of life in a majority of patients Ben-Menachem et al., 1994 Handforth et al., 1998 At the 14-weeks follow-up, about 50-60 of the patients stated that their quality of life has improved since implantation. From a psychometric point of view, reliability and validity of these data were questionable and these reports had to be considered as preliminary. But they initiated some...

Dual brain pathology in patients with affective aggression and epilepsy

Intermittent Explosive Disorder

In our studies we have demonstrated that amygdala-related brain pathology could be recognized in about half of the patients with TLE and IED. Contrary to our hypothesis however, there was no evidence for increased mesial temporal lobe sclerosis or amygdala sclerosis in the aggressive patient group. Brain pathology in patients with epilepsy and aggression was more diverse in nature and more diffuse in distribution. Interestingly, we found an increased prevalence of a history of encephalitis in...

Most Recent Scholastic Studies On Temporal Lobe Epilepsy And Dementia

Aarts, J.H., Binnie, C.D., Smit, A.M. and Wilkins, A.J. 1984 . Selective cognitive impairment during focal and generalized epileptiform EEG activity. Brain, 107, 293-308. Aldenkamp, A.P. 1995 . The impact of epilepsy on cognitive development and learning behaviour. In Epilepsy in Children and Adolescents, ed. A.P. Aldenkamp, W.O. Renier, F.E. Dreifuss and T.P.B.M. Suurmeijer, pp. 225-38. Boca Raton, FL CRC Press. Aldenkamp, A.P. 1997 . Effect of seizures and epileptiform discharges on cognitive...

Violence and postictal psychosis

Violent behaviour elicited in the course of postictal psychosis deserves a special comment. The argument against the view that epilepsy is closely related to a libera tion of aggressive impulses has marked modern epileptology, with the result that epi-leptologists have almost succeeded in dismissing this old view. However, in the course of our investigation of postictal psychosis, the sporadic episodes of abrupt violent behaviour that we observed impressed us greatly. In a previous study...

Historical background

Except for the immediate effects of a seizure on mental function, such as complex partial status epilepticus and postictal confusion, modern epileptic psychoses can be categorized into three main types chronic, acute interictal and postictal psychoses. In 1953, Landolt stressed a seesaw relationship between epileptic seizures and psychoses, and proposed the concept of forced normalization. In 1963, Slater made a rather comprehensive report on chronic psychoses in patients with epilepsy Slater...

Personality

Psicosis Postictal

Seizure precipitants in sleep epilepsy SE n 127 and in awakening epilepsy AE n 90 Table 4.4. Seizure precipitants in sleep epilepsy SE n 127 and in awakening epilepsy AE n 90 Female patients only. Source Janz 1953 . Female patients only. Source Janz 1953 . In JME in particular, we have reported unusual lack of sleep and sudden awakening, and or excessive alcohol consumption, as the most common precipitating factors Janz and Christian, 1957 . Other triggering factors were less common....

The limbic system

Ventral Hippocampus

The term 'limbic system' was coined by Maclean 1952 to designate a series of structures originally delineated by Broca 1878 and Papez 1937 , plus the amygdala and its connections, which were believed to play a crucial role in mediating the exchange of information between the thinking brain cortex and the more primal animal brain diencephalon and brain stem . Broca first described the limbic lobe as the area of brain making up the rim of the cortex, including the hippocampus, cingulate cortex...

Epidemiology

A majority of studies in this area has been hospital- and institution-based. While the contribution of these studies to the current understanding of psychopathology in epilepsy has been invaluable, the strong selection bias in these studies does make the extrapolation of their findings to the majority of patients with epilepsy, who live in the community, difficult. There have been some population-based studies of psychiatric comorbidity that are summarized here. Most studies have been...

Statedependent cognitive impairment

It is important to distinguish permanent cognitive impairment on one hand from state-dependent cognitive impairment on the other. The concept of permanent cognitive impairment is readily understood. This may arise from a wide variety of causes of permanent brain damage or dysfunction that may be prenatal, perinatal or postnatal. The concept of state-dependent cognitive impairment is less widely acknowledged Besag, 1994 . What is state-dependent cognitive impairment State-dependent cognitive...

Nonepileptic seizures and dissociation

Epileptologists frequently encounter patients who present with paroxysmal events that, despite resembling epileptic episodes, are actually nonepileptic. Indeed, as many as 50 of patients referred to specialist epilepsy centres may turn out not to have epilepsy Francis and Baker, 1999 . While some nonepileptic seizures may be attributable to physical causes other than epilepsy see Gates and Erdahl, 1993 , a demonstrable organic basis is absent in many such cases. Of these, some are attributable...

Longterm irreversible effects

The direct effects of seizures will thus dissolve in the majority of the patients after the seizures are adequately controlled. Although some experimental studies, using several animal models, found damage to the hippocampus and related limbic structures after a single prolonged generalized or limbic seizure Meldrum, 1997 , there is no convincing evidence for similar effects in humans Holmes, 1991 . Even with high seizure frequency most cognitive effects will therefore dissolve after seizure...

Intermittent explosive disorder in epilepsy

In the past, few studies have addressed the relationship between different psycho-biological factors like brain pathology, IQ and demographic background, and aggression in epilepsy. While Rodin found more evidence of organic brain disease Rodin, 1973 , and Falconer 1973 reported an increased incidence of mesial temporal lobe sclerosis in aggressive patients with temporal lobe epilepsy TLE , Herzberg and Fenwick did not find any relationship between specific electroencephalography EEG or...

Jean Martin Charcot Pseudoseizures

Halstead Reitan Report Brain Damage

Psychogenic pseudoseizures are paroxysmal events which mimic epileptic seizures. While patients suffering from these symptoms are referred to neurologists because they are mistakenly believed to have epilepsy, neurologists consider the underlying disorder to be of psychological aetiology. Our observations on the nature of pseudoseizures are based on a carefully studied sample of 100 patients with pseudo-seizures evaluated over a period of 5 years at the University of Michigan Medical Center....

Epilepsy and dissociation

Although the differential diagnosis of ICD-10 and DSM-IV dissociative disorders explicitly requires the exclusion of symptoms with an identifiable neurological basis, many of the phenomena associated with epilepsy, particularly temporal lobe epilepsy, have been regarded as dissociative in nature Devinsky et al., 1989 Good, 1993 . Indeed, ICD-10 includes a specific category for dissociative disorders due to a general medical condition, which encompasses many of the symptoms exhibited by...

Neurological disease in which both dementia and seizures occur

It is well recognized that symptomatic seizures occur in the context of dementia syndromes in older people Forsgren et al., 1996 . Breteler et al. 1995 found that people aged 50-75 with a diagnosis of epilepsy had an overall relative risk of 1.5 of subsequently developing a dementia, which they described as a moderately increased risk over the expected rate. People with Down's syndrome are at particular risk of developing early Alzheimer's disease, and this is frequently associated with...

Newer antidepressant drugs

There have been several developments of antidepressants since the tricyclic era. Some drugs have briefly been mentioned above, which were nontricyclic, such as mianserin, maprotiline and viloxazine. However, the major development in the last few years has been of agents that selectively inhibit reuptake and either noradren-aline, or serotonin, or both. Table 20.3 shows a list of the newer drugs. Table 20.4 gives a receptor profile and the epileptogenic potential of these compounds. In brief,...

Aggression and epilepsy

The relationship between epilepsy and aggressive behaviour is a particularly controversial issue Geschwind, 1975 . While in patients with episodic affective aggression, a history of epilepsy is reported to be more common Bach-Y-Rita et al., 1971 Elliot, 1982 most of the community-based studies did not find an increased prevalence of aggressive behaviour in patients with epilepsy Kligman and Goldberg, 1975 Lishman, 1998 . The prevalence of aggression in epilepsy in general, not regarding the...

Treatment of aggression in epilepsy

If aggression is a problem in the clinical management of patients with epilepsy the most important point is to establish a correct diagnosis Figure 7.5 . A careful neurological, psychiatric and medical history and examination should be performed to answer the following questions 1. Is there any medical condition that contributes to the aggressive behaviour such as endocrinological or immunologi-cal diseases Is there any medication that might contribute to the aggressive behaviour 2. What is the...

Behavioural correlates of frontal lobe epilepsy

If we propose problems with behaviour selection initiation and inhibition as a functional complex which is mainly affected in frontal lobe epilepsy, the obvious question is whether or not this dysfunction has a correlate in personality and behaviour. With respect to this question we applied several self-rating scales to a group of 95 patients with either frontal n 18 or mesial temporal lobe epilepsy n 77 . Epilepsy groups were matched regarding sex, the age at the onset of epilepsy mean 11...

Kalogjera-sackellares D Sackellares Jc. Intellectual And Neuropsychological Features Of Patients With Psychogenic

Alper, K., Devinsky, O., Perrine, K., Vazquez, B. and Luciano, D. 1993 . Nonepileptic seizures and childhood sexual and physical abuse. Neurology, 43, 1950-3. Arnold, L.M. and Privitera, M.D. 1996 . Psychopathology and trauma in epileptic and psychogenic seizure patients. Psychosomatics, 37, 438-43. Binder, L.M., Kindermann, S.S., Heaton, R.K. and Salinsky, M.C. 1998 . Neuropsychologic impairment in patients with nonepileptic seizures. Arch Clin Neuropsychology, 13, 513-22. Boll, T.J. 1981 ....

Neurobiology of aggression

Behbehani, 1995 Brandao et al., 1994 . These structures are controlled by higher neuronal centres in the hypothalamus Bhatnagar and Dallman, 1998 Van de Poll and Van Goozen, 1992 which in addition to controlling these behavioural brainstem programs adjust the internal endocrinological and immunological environment to aggressive behaviour in flight-fight situations Luo, 1998 Reis, 1969 Shaikh, 1997 Zanchetti, 1968 . Frontal lobe functions are known to be crucial for the ability to suppress...

A review of some early studies

A number of laboratory and clinical investigations were carried out to assess the effect of tricyclic drugs on seizures and the seizure threshold. The early laboratory Table 20.1. Classification of psychotic drugs Antidepressants Antipsychotics Minor tranquillizers Mood stabilizers Psychostimulants Others beta blockers etc. investigations essentially revealed the proconvulsant effect of these agents, and it emerged from these studies that clomipramine, amitriptyline and maprotiline were...