Posttraumatic stress disorder caused by the misattribution of seizure-related experiential responses

Abstract

Patients with temporal lobe seizures sometimes experience what John Hughlings Jackson described as "dreamy states" during seizure onset. These phenomena may be characterized by a re-experiencing of past events, feelings of familiarity (déjà vu), and hallucinations. In previous reports, patients have been aware of the illusory nature of their experiences. Here, however, the case of a patient with a documented 37-year history of temporal lobe epilepsy who is not aware is described. Fifteen years ago, the patient saw visions of traumatic autobiographical events that he had never previously recalled. He believed them to be veridical memories from his childhood, although evidence from his family suggests that they were not. The patient's psychological reaction to the "recovery" of these traumatic "memories" was severe enough to qualify as posttraumatic stress disorder (PTSD). To our knowledge, this is the first report of PTSD caused by the misattribution of mental states that accompany a seizure.

Déjà Experiences in Temporal Lobe Epilepsy

“…However, a handful of recent case reports document the occurrence of more debilitating forms of déjà experiences. For example, Cohen et al [ 80 ] report a man with a long history of complex TLE, who after experiencing a concussion following a seizure, began to encounter vivid intrusions of traumatic events. However, investigation of his history and questioning his family revealed that although aspects of these events did occur, the memories he was recalling were not veridical.…”

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

“…The third – Regardless of the anatomical proximity, this interaction could also be related to the psychological reaction to stress. It could be argued that the epileptic activity might have an affective negative bias ( Clark, 1920 ; Gunn and Baram, 2017 ; Lang et al, 2018 ), and that this bias can lead to increased stress and anxiety thus triggering PTSD related anxiety ( Cohen et al, 2010 ) forming a vicious cycle. In this regard, PTSD related stress might lead to a reactive seizure and vice versa ( Greig and Betts, 1992 ).…”

“…First, as we had only limited collateral information regarding the actual sexual assault, it could be claimed that what seemed to be an enactment of the assault as observed in the new seizures type was a déjà vu experience or false reminiscences as describe by Hughlings Jackson ( Hughlings-Jackson, 1880 ). Such false reminiscences can even lead in rare cases to a PTSD-like clinical picture ( Stewart and Bartucci, 1986 ; Cohen et al, 2010 ). Second, we limited our analysis to the fear circuitry of PTSD and did not assess other potential circuits involved in PTSD, such as emotional regulation and context processing ( Sheynin and Liberzon, 2017 ).…”

“…A PubMed search performed on August 11, 2018 with PTSD or Post Traumatic Stress Disorder and TLE or Temporal Lobe Epilepsy or complex partial seizures as keywords yielded only eight relevant hits, including five case reports ( Stewart and Bartucci, 1986 ; Smith et al, 2008 ; Cohen et al, 2010 ; Koubeissi, 2012 ; Cuomo et al, 2017 ), two case series with a total of 25 cases ( Greig and Betts, 1992 ; de Barros et al, 2018 ), and a theoretical paper ( Moreno and Peel, 2004 ). These publications discuss various elements of the association between TLE and PTSD; including a traumatic event leading to the activation and onset of an epileptic disorder ( Greig and Betts, 1992 ), TLE being misdiagnosed as PTSD ( Stewart and Bartucci, 1986 ; Koubeissi, 2012 ), and PTSD secondary to TLE ictal experiences ( Cohen et al, 2010 ). In addition, more general aspects are also mentioned, including the epidemiology of TLE-PTSD co-occurrence ( de Barros et al, 2018 ), diagnostic considerations between TLE and PTSD in the evaluation of patients following head trauma ( Moreno and Peel, 2004 ), and clinical pharmacological interventions suggested for this co-occurrence ( Cuomo et al, 2017 ).…”

“…TLE being misdiagnosed as PTSD and vice versa stem from several common characteristics shared by these two conditions, that may, at times, lead to confusion ( Stewart and Bartucci, 1986 ; Greig and Betts, 1992 ; Moreno and Peel, 2004 ; Cohen et al, 2010 ; Koubeissi, 2012 ). These similarities are evident in the clinical presentation, as well as in the related neuroanatomy and the suggested brain mechanisms involved.…”