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AGGRESSIVE ATTACKS FOLLOWING SEIZURES: PATTERNS DETECTED

Some normally nonviolent in-dividuals exhibit bizarre and frightening aggression following epileptic seizures. In an attempt to learn more about what prompts this behavior, M. Elizabeth Gerard and colleagues combed their database of 1,300 patients and identified six who experienced post-seizure aggressive episodes. Among the patients they studied:

  • One 42-year-old man, an auto mechanic, had suffered seizures since an episode of meningitis in early childhood. The man's behavior is normal except during periods of increased seizure activity. "During these times," the researchers say, "he exhibits a post-ictal [post-seizure] psychotic state characterized by religious preoccupations, hypersexuality, auditory hallucinations, occasional visual hallucinations of God, and paranoid delusions." He has committed a number of violent acts during these phases, including attempting to stab his sister. "The psychosis typically begins 6 to 24 hours after the last seizure," Gerard et al. say, "and lasts from several hours to several days."

  • One 32-year-old man, who suffered from seizures beginning in childhood, developed post-seizure aggression in his teenage years following experimentation with illegal drugs. His aggressive behaviors typically lasted from 20 minutes to one hour. "If the patient's mother was in the vicinity," the researchers say, "he would actively seek her out, and display both physical and verbal aggressive behavior toward her alone."

  • A 55-year-old military veteran, with seizures of unknown origin, experienced several post-seizure aggressive episodes so violent he required hospitalization. Following the seizures, the researchers say, the man believed that people wearing red represented the devil and would attempt to take off their clothes, fighting them if they resisted. "He has attacked family members with knives and broken bottles," the researchers say, "and has attempted to `baptize' his own child by immersing her in a swimming pool."
The six patients they studied, Gerard et al. say, showed no consistent pattern of age, seizure cause, or right-left seizure focus. However, some common patterns emerged. All of the patients were male, and the researchers note that in all cases, "the episodes of post-ictal aggression were not isolated events, but recurred repeatedly," with symptoms unique to each patient. In addition, the aggressive episodes tended to follow clusters of seizures, rather than single seizures. Furthermore, all of the patients had intractable epilepsy, and in all cases, aggressive episodes occurred within three days of the last seizure.

The researchers note that five of the patients had no memory of their aggressive acts, and that "all of the patients were remorseful about their behaviors" following attacks. Four of the patients exhibited no mental disorders between attacks, while two had psychiatric disorders.

Gerard and colleagues say that post-seizure aggression, while rare, "appears to be a true clinical entity with several consistently observed manifestations." Similar behavior, they note, can be induced in rats with kindled seizures in the amygdala.

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"Subacute postictal aggression," M. Elizabeth Gerard, Mark C. Spitz, John A. Towbin, and Dianne Shantz, Neurology, Vol. 50, No. 2, February 1998, pp. 384-388. Address: Mark C. Spitz, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, B- 150, Denver, CO 80262.

Related Article: [2003, Vol. 9]