Increased Prevalence of Intermittent Rhythmic Delta or Theta Activity (IRDA/IRTA) in the Electroencephalograms (EEGs) of Patients with Borderline Personality Disorder

Abstract

Introduction: An increased prevalence of pathological electroencephalography (EEG) signals has been reported in patients with borderline personality disorder (BPD). In an elaborative case description of such a patient with intermittent rhythmic delta and theta activity (IRDA/IRTA), the BPD symptoms where linked to the frequency of the IRDAs/IRTAs and vanished with the IRDAs/IRTAs following anticonvulsive therapy. This observation raised a question regarding the prevalence of such EEG abnormalities in BPD patients. The aim of this retrospective study was to identify the frequency of EEG abnormalities in a carefully analyzed psychiatric collective. Following earlier reports, we hypothesized an increased prevalence of EEG abnormalities in BPD patients.Participants and Methods: We recruited 96 consecutive patients with BPD from the archive of a university clinic for psychiatry and psychotherapy, and compared the prevalence of EEG abnormalities to those of 76 healthy controls subjects. The EEGs were rated by three different blinded clinicians, including a consultant specializing in epilepsy from the local epilepsy center.Results: We found a significant increase in the prevalence of IRDAs and IRTAs in BPD patients (14.6%) compared to the control subjects (3.9%; p = 0.020).Discussion: In this blinded retrospective case-control study, we were able to confirm an increased prevalence of pathological EEG findings (IRDAs/IRTAs only) in BPD patients. The major limitation of this study is that the control group was not matched on age and gender. Therefore, the results should be regarded as preliminary findings of an open uncontrolled, retrospective study. Future research performing prospective, controlled studies is needed to verify our findings and answer the question of whether such EEG findings might predict a positive response to anticonvulsive pharmacological treatment.

Altered Intermittent Rhythmic Delta and Theta Activity in the Electroencephalographies of High Functioning Adult Patients with Autism Spectrum Disorder

“…The phenomenon of HV-induced high-amplitude rhythmic slow activity with altered awareness in children without epilepsy was described as an epileptiform occurrence and physiological process (Barker et al, 2012 ). In this study, we focused on automatic detection of IRDA/IRTA, which is clearly pathological excitatory neuronal network activity (Tebartz van Elst et al, 2016a ).…”

“…Structurally, the delta rhythm might be generated in the thalamus or basal nuclei (Cobb, 1945 ). We earlier hypothesized that IRDA/IRTA can induce adaptive homeostatic processes, which could lead to functional alternations in neuronal networks (Tebartz van Elst et al, 2011 , 2016a ; Tebartz van Elst and Perlov, 2013 ; Endres et al, 2016 ).…”

Schizophrenia Associated with Epileptiform Discharges without Seizures Successfully Treated with Levetiracetam

“…The repetitive excitatory activity, as documented by consecutive EEGs in our patient, could have exceeded a critical threshold, leading to the successive hyperinhibition of cerebral networks. Following the LANI hypothesis, the symptoms are due to the secondary induced processes of hyperinhibition (e.g., temporal hyperinhibition might have led to auditory hallucinations or memory deficits) ( 2 – 5 , 17 ).…”

The Neuronal Excitability Spectrum: A New Paradigm in the Diagnosis, Treatment, and Prevention of Mental Illness and Its Relation to Chronic Disease

“…Such chaotic brain signaling would be more likely to occur in patients with extremely high levels of neuronal excitability, such as those with schizophrenia, bipolar disorder, borderline personality disorder, and other severe psychiatric disorders. That such patients have exceptionally high levels of neuronal excitability is corroborated by the elevated risk of seizures that they have in comparison to those with less debilitating psychiatric disorders [23,35,36,59].…”