A Long‐Term Clinical Course of Psychomotor Epilepsy (I)

Abstract

SUMMARY A comparative study of clinical features and outcome was undertaken in 21 epileptic patients, five suffering from isolated psy‐chomotor seizure without generalized convulsion (Group A), seven suffering from psychomotor seizure combined with generalized convulsion, from which complication they have been freed for over five years (Group B), and nine suffering from psychomotor seizure combined with continued generalized convulsion (Group C). These patients were over 10 years old at onset and have been followed up for 10 to 19 years at the Department of Neuropsychiatry of the Kansai Medical University Hospital. The seizure components in the long‐term courses of these three groups were classified as they are under the heading of “partial seizures with complex symptomatology” in the “Clinical and Electroencephalographid Classification of Epileptic Seizures” proposed by the International League Against Epilepsy. The nature of the seizures is monotonous and little varied in Group A and quite varied in Groups B and C. It seems to be a significant difference between isolated group and combined one regarding partial seizures with cognitive symptomatology. Partial seizures with dysmnesic disturbances seem to be closely related to the presence of generalized convulsion. The contents of forced thinking tend to remain the same from one seizure to another in the isolated group, while they differ considerably in the combined one. In the strict sense, forced thinking differs from obsessive idea and is rather similar to autochthonous idea. Episodic moodiness during seizure intervals is more clearly seen in the isolated group than in the combined one, but this tendency is also obvious in Group B. Episodic psychotic state appears much more frequently in the combined groups than in the isolated one, and it appears on an average of 14 years of the course. Deterioration in basic EEG rhythm is seen in a majority of cases, most of which belong to the combined group. Change in basic EEG rhythm is not seen in patients freed from generalized convulsion particularly in whom it has disappeared early. In long‐term clinical courses lasting more than 10 years, the disappearance of generalized convulsion leads to the disappearance or diminution of automatisms, but it also leads to the appearance or augmentation of autonomic seizure and affective seizure. Forced thinking tends to be perceptive and to develop to hallucinatory delusional experience through its repeated appearance over a long period of time. As to outcome, all the isolated psychomotor cases improved, while half the combined cases showed no change or became worse. The prognosis for cases with continuous generalized convulsion is bad. These findings suggest that many of the symptoms in patients with psychomotor seizures are closely connected with the presence of generalized convulsion.