Orgasm‐induced Seizures: A Study of Six Patients

Özkara, Çiğdem; Özdemir, Sebati; Yılmaz, Aynur; Uzan, Mustafa; Yeni, Naz; Ozmen, Mustafa

doi:10.1111/j.1528-1167.2006.00648.x

Cited by 36 publications

(35 citation statements)

References 18 publications

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“…The right temporal lobe with its embedded amygdalar nuclei participate in the perception of sexual behavior and in the inhibition of sexual thoughts and impulses (Ozkara et al, 2006; Tiihonen et al, 1994). Although simple viewing of sexual stimuli is associated with amygdalar activation (Hamann et al, 2004), there is deactivation of temporal areas, including the amygdalae during erection and orgasm (Holstege et al, 2003; Redouté et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease

Mendez

Shapira

2013

Arch Sex Behav

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The basis of hypersexual behavior among patients with dementia is not entirely clear. Hypersexual behavior may be a particular feature of behavioral variant frontotemporal dementia (bvFTD), which affects ventromedial frontal and adjacent anterior temporal regions specialized in interpersonal behavior. Recent efforts to define Hypersexual Disorder indicate an increasing awareness of heightened sexual activity as a source of personal distress and functional impairment, and clarification of hypersexuality in bvFTD could contribute to understanding the neurobiology of this behavior. This study reviewed 47 patients with bvFTD compared to 58 patients with Alzheimer’s disease (AD) for the presence of heightened sexual activity to the point of distress to caregivers and others. Hypersexual behavior occurred in 6 (13%) bvFTD patients compared to none of the AD patients. Caregivers judged all six bvFTD patients with hypersexual behavior as having a dramatic increase in sexual frequency from premorbid levels. All had general disinhibition, poor impulse control, and actively sought sexual stimulation. They had widened sexual interests and experienced sexual arousal from previously unexciting stimuli. One patient, with early and predominant right anterior temporal involvement, was easily aroused by slight stimuli, such as touching her palms. Although previously considered to be predominantly disinhibited sexual behavior as part of generalized disinhibition, these patients with dementia illustrate varying degrees of increased sexual desire. We conclude that bvFTD is uniquely associated with hypersexuality; it is more than just cognitive impairment with frontal disinhibition but also involves alterations in sexual drive, possibly from right anterior temporal-limbic involvement in this disease.

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Section: Discussionmentioning

confidence: 99%

Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease

Mendez

Shapira

2013

Arch Sex Behav

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“…Hypothetically, we could speculate that the cerebral processing involved in the poststartle reaction, or the so‐called orienting reaction, which has also been observed in humans (Valls‐Solé et al., 2008), could be the trigger/responsible for the development of startle‐induced seizures when these areas physiologically involved in the orienting reaction overlap with the epileptogenic zone. Therefore, when a critical mass of epileptogenic cortex is activated in response to a determined stimulus related to the SR (startle, sensory input, emotion), it could recruit and synchronize neuronal pools fast, resulting in an unexpected seizure (Ferlazzo et al., 2005; Palmini et al., 2005; Ozkara et al., 2006; D′Souza et al., 2007). That could also explain the delay observed between the initial SR and the generation of the startle‐induced seizures that has invariably been observed in these seizure types.…”

Section: Discussionmentioning

confidence: 99%

Functional neuroimaging in startle epilepsy: Involvement of a mesial frontoparietal network

et al. 2011

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Purpose: Startle epilepsy is a rare form of epilepsy with seizures triggered by unexpected stimuli. Previous studies have suggested the participation of several brain regions, such as the supplementary motor area (SMA) or the mesial aspect of the frontal and parietal lobes in the generation of startle epilepsy. However, how these brain regions interact with each other during seizures remains largely unknown. The aim of this study was to get insight into brain structures involved in startle-induced seizures using an approach with functional neuroimaging. Methods: Four patients with startle epilepsy secondary to unexpected sounds were studied. All of them underwent a presurgical evaluation including ictal-single-emission computed tomography/subtraction ictal SPECT coregis-tered to MRI (magnetic resonance imaging) (SPECT/ SISCOM). We searched for areas with ictal changes of perfusion higher than two standard deviations (2 SD) above the reference. In one patient, a fluorodeoxyglu-cose-positron emission tomography (FDG-PET) and an ictal electroencephalography-functional MRI (EEG-fMRI) were also performed. In this patient, the results of FDG-PET and sequential analysis of EEG-fMRI were compared to SISCOM. Key Findings: All the patients had their typical startle-induced seizures, consistent with bilateral asymmetric tonic seizures. Ictal-EEG pattern was located over the mesial centroparietal region in all of them. In three of four patients, a significant hyperperfusion over the mesial frontocentral region was seen, involving the SMA, the perirolandic region, and the precuneus. In one patient, who had a congenital bilateral perisylvian polymicrogyria, it was located over the lateral perirolandic region. 18F-FDG-PET results in the patient in whom it was done, were concordant with SISCOM findings. Ictal EEG-fMRI showed an initial activation located over the precuneus, SMA, cingulate gyrus, and the precentral/perirolandic area. Significance: By using a functional neuroimaging approach we have found that startle-induced seizures could be generated by the interaction of a frontoparietal network located over the mesial surface of the brain.

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“…Activation of frontal regions, including the right prefrontal, orbitofrontal, and anterior cingulate cortices, occurs during sexual arousal [14,21,[24][25][26][27]. The temporal lobes, in particular the amygdalae, especially on the right, are dominant for the perception of sexual behavior and appears to inhibit sexual thoughts and impulses [25,[28][29][30][31]. The non-motor basal ganglia loops including the globus pallidus and ansa lenticularis participate in sexual arousal and the hypothalamus in the neuroendocrine and autonomic manifestations of sexual behavior [21,24,27,32].…”

Section: Discussionmentioning

confidence: 99%

Pedophilic Behavior from Brain Disease

Mendez

Shapira

2011

The Journal of Sexual Medicine

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Introduction Child molestation or other pedophilic behavior may result as a consequence of a brain disorder. Aim To characterize the mechanisms of pedophilic behavior associated with neurological diseases. Methods We report eight patients with pedophilic behavior as a manifestation of their brain disorder and review the literature. Main Outcome Measures The sexual, neuropsychiatric, and neurological aspects of a series of patients. Results All eight developed sexual behavior toward prepubescent children in mid- to late-life coincident with the development of a neurological disorder. Five had limited insight, anxiety, or concern for their behavior and tended to have frontal lobe executive deficits. Most of this group had frontally predominant disorders. Two others retained insight and concern in the context of marked hypersexuality. This second group had treated Parkinson’s disease and resembled reports of pedophilic behavior from subcortical lesions. The further presence of right temporal lobe-amygdala involvement may have predisposed to specific sexual preoccupation in some patients. Conclusions Brain disorders may release a predisposition to sexual attraction for children through disinhibition with frontal disease, sexual preoccupation with right temporal disease, or hypersexuality with subcortical disease in non-motor basal ganglia, hypothalamus, or septal nuclei. Differentiating these mechanisms of pedophilic behavior from brain disease could facilitate targeted interventions.

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Orgasm‐induced Seizures: A Study of Six Patients

Cited by 36 publications

References 18 publications

Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease

Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease

Functional neuroimaging in startle epilepsy: Involvement of a mesial frontoparietal network

Pedophilic Behavior from Brain Disease

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