Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case

Abstract

In this case study, we present a 21 years old female with long-standing Temporal Lobe Epilepsy (TLE) who, following a sexual assault, also developed Posttraumatic Stress Disorder (PTSD), leading to a change in her seizure semiology. The new seizures seemed to be a re-enactment of the sexual assault and accordingly were at first thought to be Psychogenic Non-Epileptic Seizures (PNES). Nevertheless, electroencephalography (EEG) recording at the Epilepsy Monitoring Unit (EMU) revealed ictal epileptic brain activity during these new attacks. In order to further explore the nature of the relation between epileptic seizures and PTSD symptomatology, a functional MRI (fMRI) scan was conducted focusing on neural response to threat (fearful faces). The results indicated that the response to threat elicited bilateral amygdala activation, as well as enhanced amygdala connectivity with the insula and anterior cingulate cortex (ACC), all central nodes of the fear circuitry. Accordingly, we suggest that this unique presentation of “pseudo” PNES might stem from the anatomical proximity of the epileptic network in this patient (temporal-insular-frontal) to the fear circuitry, allowing abnormal epileptic activity to “exploit” or activate the fear circuit or vice versa. We further propose that the traumatic experience may have changed the patient’s ictal semiology by modifying the course of the spread of the ictal activity toward the PTSD network.

Self-perceived burden and associated factors in Chinese adult epilepsy patients: A cross-sectional study

“…An electroencephalogram is an important method for diagnosing epilepsy and evaluating the effectiveness of treatment ( 43 , 44 ). This study showed that patients with abnormal electroencephalogram findings had a higher SPB than those with normal electroencephalogram findings.…”

“…The more types of medicines taken, the greater the physical, psychological and economic burden of the patient, and the higher the SPB. An electroencephalogram is an important method for diagnosing epilepsy and evaluating the effectiveness of treatment (43,44). This study showed that patients with abnormal electroencephalogram findings had a higher SPB than those with normal electroencephalogram findings.…”

Post-traumatic stress disorder (PTSD) in patients with epilepsy

“…They also reported experiencing more intrusions (thoughts or memories) during the seizure itself (ictal period) than patients without PTSD symptoms. In this way, some case reports have mentioned that epilepsy patients with severe PTSD may have a specific seizure semiology, in that re-experiencing of a traumatic memory may occur during the ictal period [38,39]. These findings presuppose an interaction within limbic networks, particularly involving amygdala hyperactivity that characterizes traumatic memory and epileptogenic networks [22,38,39].…”

“…In this way, some case reports have mentioned that epilepsy patients with severe PTSD may have a specific seizure semiology, in that re-experiencing of a traumatic memory may occur during the ictal period [38,39]. These findings presuppose an interaction within limbic networks, particularly involving amygdala hyperactivity that characterizes traumatic memory and epileptogenic networks [22,38,39]. Repeated exposure to seizures can act as a reinforcer of PTSD according to a mechanism similar to fear conditioning, one major axis of neurobiological theories of PTSD [40].…”