Individualized patientdriven QOL assessment techniques
There is a fundamental tension in the measurement of QOL. Since what is deemed important for QOL is acknowledged to be subjective and idiosyncratic, differences being influenced by a variety of personal and cultural factors, an appraisal of QOL should strive to capture the individual's subjectively appraised phenomenological experience. On the other hand, the hallmark of scientific measurement is reliable, 'objective', empirical data collection. Researchers have devised QOL measurement...
Violence and postictal psychosis
Violent behaviour elicited in the course of postictal psychosis deserves a special comment. The argument against the view that epilepsy is closely related to a libera tion of aggressive impulses has marked modern epileptology, with the result that epi-leptologists have almost succeeded in dismissing this old view. However, in the course of our investigation of postictal psychosis, the sporadic episodes of abrupt violent behaviour that we observed impressed us greatly. In a previous study...
Historical background
Except for the immediate effects of a seizure on mental function, such as complex partial status epilepticus and postictal confusion, modern epileptic psychoses can be categorized into three main types chronic, acute interictal and postictal psychoses. In 1953, Landolt stressed a seesaw relationship between epileptic seizures and psychoses, and proposed the concept of forced normalization. In 1963, Slater made a rather comprehensive report on chronic psychoses in patients with epilepsy Slater...
Personality
Table 4.4. Seizure precipitants in sleep epilepsy SE n 127 and in awakening epilepsy AE n 90 Table 4.4. Seizure precipitants in sleep epilepsy SE n 127 and in awakening epilepsy AE n 90 Female patients only. Source Janz 1953 . Female patients only. Source Janz 1953 . In JME in particular, we have reported unusual lack of sleep and sudden awakening, and or excessive alcohol consumption, as the most common precipitating factors Janz and Christian, 1957 . Other triggering factors were less common....
The limbic system
The term 'limbic system' was coined by Maclean 1952 to designate a series of structures originally delineated by Broca 1878 and Papez 1937 , plus the amygdala and its connections, which were believed to play a crucial role in mediating the exchange of information between the thinking brain cortex and the more primal animal brain diencephalon and brain stem . Broca first described the limbic lobe as the area of brain making up the rim of the cortex, including the hippocampus, cingulate cortex...
Epidemiology
A majority of studies in this area has been hospital- and institution-based. While the contribution of these studies to the current understanding of psychopathology in epilepsy has been invaluable, the strong selection bias in these studies does make the extrapolation of their findings to the majority of patients with epilepsy, who live in the community, difficult. There have been some population-based studies of psychiatric comorbidity that are summarized here. Most studies have been...
Statedependent cognitive impairment
It is important to distinguish permanent cognitive impairment on one hand from state-dependent cognitive impairment on the other. The concept of permanent cognitive impairment is readily understood. This may arise from a wide variety of causes of permanent brain damage or dysfunction that may be prenatal, perinatal or postnatal. The concept of state-dependent cognitive impairment is less widely acknowledged Besag, 1994 . What is state-dependent cognitive impairment State-dependent cognitive...
Nonepileptic seizures and dissociation
Epileptologists frequently encounter patients who present with paroxysmal events that, despite resembling epileptic episodes, are actually nonepileptic. Indeed, as many as 50 of patients referred to specialist epilepsy centres may turn out not to have epilepsy Francis and Baker, 1999 . While some nonepileptic seizures may be attributable to physical causes other than epilepsy see Gates and Erdahl, 1993 , a demonstrable organic basis is absent in many such cases. Of these, some are attributable...
Introduction 1
The association between epilepsy and psychiatric disorders has a long and chequered history. For centuries seizures were considered to be a form of demonic possession. Beginning late in the nineteenth century, considerable attention has been directed towards cataloguing, describing and understanding disorders at the interface between epilepsy and psychiatry, particularly by European neurologists and psychiatrists. However, it is only in the past few decades that any attention has been paid to...
References Efg
Alho, K., Winkler, I., Escera, C. et al. 1998 . Processing of novel sounds and frequency changes in the human auditory cortex magnetoencephalographic recordings. Psychophysiology, 35, 211-24. American Psychiatric Association 1987 . Diagnostic and Statistical Manual of Mental Disorders and Related Health Problems Third Edition, Revised DSM-III-R . Washington, DC APA. Barraclough, B. 1981 . Suicide and epilepsy. In Epilepsy and Psychiatry, ed. E.H. Reynolds and M.R. Trimble, pp. 72-6. Edinburgh...
Longterm irreversible effects
The direct effects of seizures will thus dissolve in the majority of the patients after the seizures are adequately controlled. Although some experimental studies, using several animal models, found damage to the hippocampus and related limbic structures after a single prolonged generalized or limbic seizure Meldrum, 1997 , there is no convincing evidence for similar effects in humans Holmes, 1991 . Even with high seizure frequency most cognitive effects will therefore dissolve after seizure...
Intermittent explosive disorder in epilepsy
In the past, few studies have addressed the relationship between different psycho-biological factors like brain pathology, IQ and demographic background, and aggression in epilepsy. While Rodin found more evidence of organic brain disease Rodin, 1973 , and Falconer 1973 reported an increased incidence of mesial temporal lobe sclerosis in aggressive patients with temporal lobe epilepsy TLE , Herzberg and Fenwick did not find any relationship between specific electroencephalography EEG or...
Introduction Tmj
Psychogenic pseudoseizures are paroxysmal events which mimic epileptic seizures. While patients suffering from these symptoms are referred to neurologists because they are mistakenly believed to have epilepsy, neurologists consider the underlying disorder to be of psychological aetiology. Our observations on the nature of pseudoseizures are based on a carefully studied sample of 100 patients with pseudo-seizures evaluated over a period of 5 years at the University of Michigan Medical Center....
Epilepsy and dissociation
Although the differential diagnosis of ICD-10 and DSM-IV dissociative disorders explicitly requires the exclusion of symptoms with an identifiable neurological basis, many of the phenomena associated with epilepsy, particularly temporal lobe epilepsy, have been regarded as dissociative in nature Devinsky et al., 1989 Good, 1993 . Indeed, ICD-10 includes a specific category for dissociative disorders due to a general medical condition, which encompasses many of the symptoms exhibited by...
Neurological disease in which both dementia and seizures occur
It is well recognized that symptomatic seizures occur in the context of dementia syndromes in older people Forsgren et al., 1996 . Breteler et al. 1995 found that people aged 50-75 with a diagnosis of epilepsy had an overall relative risk of 1.5 of subsequently developing a dementia, which they described as a moderately increased risk over the expected rate. People with Down's syndrome are at particular risk of developing early Alzheimer's disease, and this is frequently associated with...
Personality disorders a gateway to an individual understanding of patients
After a period of 20 years of neglect, a growing scientific interest has again been directed to personality disorders during the last decade. One reason is our increasing knowledge about the neurobiological basis of behaviour. Questions about the demarcation of personality disorders from manifest psychiatric syndromes at one end and from normal variants of behaviour patterns at the other end have been discussed, as well as the aetiological components and the predictive value of personality...
Conclusion 1
Further neuropsychiatric studies of patients with epilepsy who commit suicide need to be made available before one can draw more definite conclusions about all the modes of suicide in epilepsy. The current review allows a number of conclusions, similar to those reached earlier by Diehl 1986 , but more specific in nature. Suicide in epilepsy results from the psychiatric disorder of temporal lobe epilepsy that is, from a severe dysphoric disorder, from interictal psychosis associated with...
Newer antidepressant drugs
There have been several developments of antidepressants since the tricyclic era. Some drugs have briefly been mentioned above, which were nontricyclic, such as mianserin, maprotiline and viloxazine. However, the major development in the last few years has been of agents that selectively inhibit reuptake and either noradren-aline, or serotonin, or both. Table 20.3 shows a list of the newer drugs. Table 20.4 gives a receptor profile and the epileptogenic potential of these compounds. In brief,...
Aggression and epilepsy
The relationship between epilepsy and aggressive behaviour is a particularly controversial issue Geschwind, 1975 . While in patients with episodic affective aggression, a history of epilepsy is reported to be more common Bach-Y-Rita et al., 1971 Elliot, 1982 most of the community-based studies did not find an increased prevalence of aggressive behaviour in patients with epilepsy Kligman and Goldberg, 1975 Lishman, 1998 . The prevalence of aggression in epilepsy in general, not regarding the...
Treatment of aggression in epilepsy
If aggression is a problem in the clinical management of patients with epilepsy the most important point is to establish a correct diagnosis Figure 7.5 . A careful neurological, psychiatric and medical history and examination should be performed to answer the following questions 1. Is there any medical condition that contributes to the aggressive behaviour such as endocrinological or immunologi-cal diseases Is there any medication that might contribute to the aggressive behaviour 2. What is the...
Origins of neuropsychology
The origins of neuropsychology lie in direct clinical observation. Two nineteenth century landmarks in the understanding of structural and functional relationships in the brain were the observations of Broca and Wernicke. In 1861 Paul Broca identified the third frontal convolution of the left hemisphere as an area that if damaged, would result in a specific impairment of expressive language. In 1874 Karl Wernicke described specific impairment of receptive language associated with damage to an...
Behavioural correlates of frontal lobe epilepsy
If we propose problems with behaviour selection initiation and inhibition as a functional complex which is mainly affected in frontal lobe epilepsy, the obvious question is whether or not this dysfunction has a correlate in personality and behaviour. With respect to this question we applied several self-rating scales to a group of 95 patients with either frontal n 18 or mesial temporal lobe epilepsy n 77 . Epilepsy groups were matched regarding sex, the age at the onset of epilepsy mean 11...
Kalogjera-sackellares D Sackellares Jc. Intellectual And Neuropsychological
Alper, K., Devinsky, O., Perrine, K., Vazquez, B. and Luciano, D. 1993 . Nonepileptic seizures and childhood sexual and physical abuse. Neurology, 43, 1950-3. Arnold, L.M. and Privitera, M.D. 1996 . Psychopathology and trauma in epileptic and psychogenic seizure patients. Psychosomatics, 37, 438-43. Binder, L.M., Kindermann, S.S., Heaton, R.K. and Salinsky, M.C. 1998 . Neuropsychologic impairment in patients with nonepileptic seizures. Arch Clin Neuropsychology, 13, 513-22. Boll, T.J. 1981 ....
Neurobiology of aggression
Behbehani, 1995 Brandao et al., 1994 . These structures are controlled by higher neuronal centres in the hypothalamus Bhatnagar and Dallman, 1998 Van de Poll and Van Goozen, 1992 which in addition to controlling these behavioural brainstem programs adjust the internal endocrinological and immunological environment to aggressive behaviour in flight-fight situations Luo, 1998 Reis, 1969 Shaikh, 1997 Zanchetti, 1968 . Frontal lobe functions are known to be crucial for the ability to suppress...
A review of some early studies
A number of laboratory and clinical investigations were carried out to assess the effect of tricyclic drugs on seizures and the seizure threshold. The early laboratory Table 20.1. Classification of psychotic drugs Antidepressants Antipsychotics Minor tranquillizers Mood stabilizers Psychostimulants Others beta blockers etc. investigations essentially revealed the proconvulsant effect of these agents, and it emerged from these studies that clomipramine, amitriptyline and maprotiline were...
Cerebral mechanisms of action
A further development of the indications and the effectiveness of VNS depends on a comprehensive understanding of the mechanisms of action underlying VNS. Theoretical considerations have to rely on the anatomical conditions of the vagus George et al., 2000 Rutecki, 1990 , functional imaging studies Henry et al., 1998, 1999 Vonck et al., 2000 , studies on the neurochemical effects of VNS in epilepsy patients Ben-Menachem et al., 1995 Hammond et al., 1992b Naritoku et al., 1995 Walker et al.,...