Neuropsychiatric Symptoms of Epilepsy

Chapter 7
Aggressive Behavior
Hesham Yousry Elnazer and Niruj Agrawal
Abstract Epilepsy was considered to be commonly associated with aggression historically.
It has also been emphasized in medicolegal settings. However, the link
between epilepsy and directed aggression is now noted to be less clear-cut even
though brief and non-directed aggression can occur not so uncommonly. Aggression
in epilepsy could be linked to a number of factors including seizures or the underlying
electrophysiological activity of the brain, neuropsychiatric comorbidities, antiepileptic
drugs or underlying brain damage which may cause aggression and
epilepsy both. Common clinical presentations of aggressive behaviors in epilepsy
and their pathogenesis are discussed. A clinical approach to assess and manage
these problems is described and related evidence is discussed.
Keywords Epilepsy • Aggression • Agitation • Automatism • Intermittent Explosive
Disorder
Introduction
Epilepsy is one of the oldest known illnesses. Seizures were believed to be associated
with evil procession causing violent movements and aggressive behaviors.
Throughout history, the disorder was thought to be of a spiritual nature. The world’s
oldest description of an epileptic seizure goes back to Mesopotamia around 2000
BC. A person was described as being under the influence of a moon god with violent
movements and disruptive behaviour and subsequently underwent exorcism.
Epileptic seizures are listed in the Code of Hammurabi (c. 1790 BC) as reason for
H.Y. Elnazer , MBBch, MRCPsych • N. Agrawal , MBBS, MD, MSc, Dip CBT, FRCPsych (*)
Department of Neuropsychiatry , St. George’s Hospital , Blackshaw Road , London SW17 0QT , UK
e-mail: doctor_hesham@yahoo.com; niruj.agrawal@swlstg-tr.nhs.uk
© Springer International Publishing Switzerland 2016
M. Mula (ed.), Neuropsychiatric Symptoms of Epilepsy, Neuropsychiatric
Symptoms of Neurological Disease, DOI 10.1007/978-3-319-22159-5_7
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