Violence and Epilepsy: A Close Relation Between Violence and Postictal Psychosis

Abstract

Summary: Purpose:We investigated the incidence of welldirected violent behavior and suicide attempts in patients with temporal lobe epilepsy, with special attention to postictal psychosis.Methods: We compared 57 episodes of postictal psychosis with 62 episodes of acute interictal (or alternative) psychosis and with 134 complex partial seizures. All patients were matched for age and for age at onset of seizures.Results: The incidence of well-directed violent behavior against human beings was significantly higher (23%) duringFor the last several decades, epileptologists have so successfully fought against the view that epilepsy is closely related to aggressive and self-destructive impulses that they have almost succeeded in dismissing this old view (1-3). While investigating postictal psychosis, however, we noticed several sporadic episodes of abrupt violent behavior. We assumed that this behavior could be explained, not by the old theories linking epilepsy in general with such aggression, but by an incomplete differentiation of postictal psychosis from postictal confusion and by a longstanding neglect of postictal psychosis. Indeed, even Treiman (I), who argued that most cases of allegedly ictal aggression were a result of artifacts of gross observations, admitted that violence does occur in postictal psychosis. However, Treiman postulated that such aggression was not fundamentally dissimilar from the aggressive behavior seen in other patients who exhibited psychotic episodes attributable to other causes. This study was designed to examine our impression that violence is one of the outstanding features of postictal psychosis.Accepted June 9, 1998. Address correspondence and reprint requests to Dr. K. Kanemoto at Utano National Hospital, Ukyo-ku, Narutaki, Ontoyama-cho 8, Kyoto, Japan.postictal psychotic episodes than during acute interictal episodes (5%) and postictal confusion (1 %). Suicide attempts were also more frequent during postictal psychosis (7%) than during either acute interictal psychosis (2%) or postictal confusion Conclusions: Our study showed that well-directed violent and self-destructive behavior was not a feature of epileptic psychosis in general but a specific hallmark of postictal psychosis.

Antiepileptics for aggression and associated impulsivity

“…A diagnostic criterion of organic personality disorder is 'irritability and/or outbursts of anger and aggression ' (World Health Organization 1993). A specific relationship between epilepsy and aggression has also been found in adults (Kanemoto 1999;van Elst 2000) and children (Connor 1996).…”

The Postictal State: A Neglected Entity in the Management of Epilepsy

“…This is quite a different circumstance from directed violence, which happens rarely, if ever, after a seizure (9,52,54). When postictal violence does occur, it may be a manifestation of postictal psychosis (28).…”

An investigation into the psychosocial effects of the postictal state

“…2 These symptoms can be extremely debilitating 3,4 and may last hours to days after a seizure. 1 However, there is a relative paucity of data related to the clinical, psychological, and social consequences of postictal cognitive and behavioral impairment (PCBI) in the current literature.…”