Neuropsychiatric Symptoms of Epilepsy

6 Obsessiveness and Viscosity
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reviewed 17 papers specifically using the inventories developed by Bear and Fedio
and concluded: (1) TLE and other epilepsy groups exhibited increased (abnormal)
scores versus healthy controls and/or neurobehavioral controls; (2) differences
between patients with TLE versus other epilepsies, such as primary generalized
epilepsies, were inconsistent; (3) epilepsy patients were poorly distinguished from
patients with psychiatric disorders; (4) laterality differences in relation to the presentation
of these personality and behavioral changes in TLE were not strongly
marked; (5) factors that could affect personality were not systematically studied; (6)
a behavioral syndrome distinctive or specific for TLE was not defined; and (7) the
behavioral inventories developed by Bear and Fedio focused interest in behavior
and epilepsy.
Additional research at the time included the development of additional assessment
techniques to assess the behaviors of interest including semi-structured interview
techniques (Behavior Rating Scales for Epilepsy [ 7 ]), other similar
questionnaires (Neurobehavioral Inventory [ 8 ]), questionnaire measures of specific
behaviors such as viscosity [ 9 ], and direct behavioral investigations of the traits of
interest which will be reviewed in more detail.
Definition of Terms
In the original Bear and Fedio publication, the proposed behavioral changes were
presented as having been based on specific clinical observations reflected in published
case studies and reports. Obsessionalism was based in observations of ritualism,
orderliness, and compulsive attention to detail. Viscosity was based in
observations of stickiness and a tendency to repetition. Related traits were circumstantiality
(characterized by loquacious, pedantic, overly detailed and peripheral
speech) and hypergraphia (characterized by keeping extensive diaries, detailed
notes, and writing autobiography or novel).
All of these terms and behaviors of course have additional meanings and some
traits have been of longer-standing interest in epilepsy. For example, in a more conventional
characterization, circumstantiality can be defined as a communication
disorder in which the focus of conversation drifts, but often comes back to the point.
Unnecessary details and irrelevant remarks cause a delay in getting to the point.
This is less severe than tangential speech where the speaker wanders and drifts but
usually never returns to the original topic. Pertinent symptoms may include slowed
thinking and speaking at length about trivial details, and eliciting information can
be difficult as circumstantiality makes it hard for the person to stay on topic. In most
instances, the relevant details are eventually achieved. For example, if one asks “At
what age did your mother die?”, the speaker may respond by talking at length about
his mother, accidents, and how too many people die in accidents, and then eventually
state the age at which his mother died (due to an accident) [ 10 ]. This particular
trait had been of interest and early views, such as expressed by Kraepelin [ 11 ], suggested
a link to epilepsy: