Neuropsychiatric Symptoms of Epilepsy

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H.Y. Elnazer and N. Agrawal
which a purchased slave may be returned for a refund [ 1 ]. The Edwin Smith Papyrus
(c. 1700 BC) describes cases of individuals with epileptic convulsions [ 2 ].
The Babylonian tablet 1067 BC (currently at the British Museum in London)
describes different seizure types, similar to what we recognize today. It also emphasizes
the supernatural nature of epilepsy, with each seizure type associated with the name of
a spirit or god—usually evil alluding to development of bad/aggressive behaviors. The
text gives signs and symptoms, different types, and details treatment and likely outcomes
[ 2 ]. Punarvasu 900 BC Atreya described epilepsy as loss of consciousness; this
definition was carried forward into the Ayurvedic text of Charaka Samhita (400 BC) [ 3 ].
The idea that epilepsy is a supernatural or spiritual disorder persisted with widespread
beliefs that it was due to possession by the devil. This notion gained popularity
through the common observation—at the time—of violent movements,
behavioral changes, and aggression. Epilepsy was also viewed as a result of a person
perpetrating evil doings, or as a consequence of cycles of the moon or mystic
magical phenomenon.
Hippocrates (c . 400 BC) was first to regard epilepsy and its associated motor and
behavioral changes as a physical disorder due to natural causes. This was contradictory
to the wide belief understanding of epilepsy as a spiritual phenomenon. Galen
of Pergamon (AD 130–200) described three types of fits, and deduced that epilepsy
was a brain disorder related to an accumulation of thick humors. Galen postulated
that the moon governs the periods of epileptic cases [ 4 ].
It was not before the nineteenth and twentieth centuries that scientific explanations
replaced and dominated the previous concepts. Nevertheless, the belief that
epilepsy is linked to violent behavior acquired popularity in the late nineteenth century
when the criminologist Cesare Lombroso promoted the association of epilepsy
with aggressive, sociopathic tendencies on the basis of degenerative theory, which
was prevalent at that time [ 4 ]. The notion of a close association between epilepsy
and violence persisted long after the Degenerative theory became widely refuted.
Up until the early 1980s, aggressive and self-destructive impulses were linked to
people with epilepsy in a popular psychiatric textbook [ 5 , 6 ]. This view gradually
lost general acceptance in the 1990s following several studies which showed that
aggressive phenomena, including destructive acts, can arise during epileptic seizures,
but are extremely rare [ 7 , 8 ].
Epidemiology
Epilepsy is a common condition with a prevalence of 8.2/1000 [ 9 ]. Risk factors for
aggression in epilepsy include organic cerebral disease, low socioeconomic status,
and poor upbringing [ 10 ]. Some data suggests higher vulnerability for patients with
intractable epilepsy to develop aggressive disorder following epilepsy surgery
including hippocampectomy or temporal lobectomy. The hippocampus and related
area have been implicated in seizure-induced behavioral and cognitive disorders
and also aggression [ 11 ].