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. Clinically, it is crucial to first of all establish a correct diagnosis. Intervening medical, neurological and psychiatric disorders, in particular depression and anxiety, should be recognized and treated adequately. A correct syndro-matic diagnosis of the aggressive syndrome and its relation to the seizures should be made. Causal treatment should aim at any underlying medical, neurological or psychiatric disorders. In symptomatic treatment of aggressive outbursts, treatment of acute aggression and prophylactic treatment should be differentiated. In acute arousal states, if possible, patients should be left alone if aggression is a symptom of a seizure since restrictive aggression is the most common form in this situation. In cases of postictal or interictal aggression, it is important to establish a possible relationship to postictal or interictal psychosis and treat adequately. For interictal syndromes of affective aggression like IED (episodic dyscontrol), there are no generally established treatment protocols. However, tentative treatment with different substances as mentioned above seems justified in single cases. Furthermore, psychotherapeutic and social interventions may help prevent arousal states and thus can be very effective.
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