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Query: UMLS:C0014544 (epilepsy)
 64,704 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There has been much controversy in the past surrounding the relationship between schizophrenia and epilepsy. One hypothesis has been that the two disorders are antagonistic. The evidence supporting the antagonism hypothesis is briefly reviewed. A new theory based on current knowledge of the relationship of dopamine to both disorders is postulated which may explain the relationship between the psychosis and epilepsy which occurs in a subgroup of schizophrenic patients. In the light of this hypothesis it is suggested that further clinical work be undertaken to clarify further the exact association between the two disorders.
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PMID:The relationship between epilepsy and schizophrenia: a biochemical hypothesis. 1 65

The experience of a neurosurgical unit devoted to the surgical therapy of the epilepsies is only based on very peculiar patients. However, relationship between a given epilepsy and associated psychiatric disorders are more easily understood because of more extensive explorations. Bilateral temporal epilepsies involving the limbic system on the one hand, bilateral frontal epilepsies on the other one, and P.M. status which may be paralleled, make these patients more susceptible to acute mental confusions, to acute thymic disorders, to delirious attacks. Direct relations between chronic psychosis and severe epilepsies are much more uncertain.
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PMID:[Epilepsy and psychoses (from the viewpoint of a neurosurgical service)]. 11 1

A 23 year-old woman died as a result of deficient food and liquid intake as well as of physical exhaustion brought about by an unchecked pathological displacement impulse. Finally pneumonia developed in a typical manner. During the previous 9 months exorcism had been carried out a total of 60 to 70 times, the last time being on the eve of her death, to "expel demons" and to heal the "possessed". Summarized the medical diagnosis of "possession" was: Parnoid-hallucinatory psychosis with epilepsy in the background of special psycho-social factors. During the time of influence by the priests who carried out the exorcism all medical treatment was denied. This, it was pointed out by the participants, occurred at the express wish of the "possessed" and also due to the conviction that medical aid would be ineffective. This fateful development took place in a milieu of belief in demons fostered by the priests and uncritical rejection of medico-scientific treatment methods. According to the results of the hearing of witnesses during the now legally valid proceedings ending with the exorcists and the deceased's parents being convicted for accidental homicide a doctor probably also participated in what happend in a reprehensible manner.
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PMID:["Possessedness" and exorcism in the year 1976 (author's transl)]. 21 35

Violence is a symptom of an underlying mental state such as a psychosis, a characterological problem, or brain dysfunction. Thus drugs used to treat aggression in man exert effects by their specific pharmacological actions (e.g., antipsychotic, anticonvulsant). Most literature to date has dealt with animals and human models of aggression and lacks conceptual clarity. Aggression differs from depression, a coherent clinical entity, in its etiological diversity and its paroxysmal or impulsive basis, and this may account for the relationship seen in literature linking violence to epilepsy; yet literature on anticonvulsants is equivocal with regard to beneficial effects on aggression. Lithium has been shown to have positive effects, although its mode of action is unclear. A variety of antipsychotic agents and minor tranquilizers have been mentioned. Central nervous system stimulants have been found useful to treat hyperkinetic syndromes in both children and adults where aggression is a symptom. Hormonal agents are discussed. Drug treatment of aggression should not obscure the need for verbal therapies, and social and environmental factors should always be regarded.
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PMID:Conceptual issues in the use of drugs for the treatment of aggression in man. 23 9

Most of the drugs used in the treatment of aggressive syndromes have originally been developed for other clinical applications. Despite significant differences in the pathogenesis of various aggressive disorders, the frequently used "antiaggression" drugs are the major tranquilizers (neuroleptics). If the aggresstion is associated with psychosis, chlorpromazine or haloperidol are the drugs of choice. Aggressive disorders within the acute and chronic brain syndromes are best treated with pericyazine, thioridazine, and thiothixene. In aggressive symptoms of mentally retarded patients, particularly with epileptic syndromes, a new benzazepine (SCH12,679)was found to be very effective. Aggression associated with alcoholism or narcotic addiction showed best response to chlorpormazine and haloperidol. As a general rule, in aggressive patients with clinically known epilepsy, or with abnormal electroencephalographic findings, the major tranquilizers with potent sedative properties should be given with great caution.
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PMID:Treatment of human aggression with major tranquilizers, antidepressants, and newer psychotropic drugs. 23 10

This survey covers 74 patients with temporal lobe epilepsy, resistant to medication, who underwent unilateral temporal lobectomy during the years 1960-1969 at Rigshospitalet, Copenhagen. Preoperatively all patients were socially incapacitated. In all patients a unilateral or predominantly unilateral temporal EEG focus was found. No tumour or gross vascular malformation had been recognized before or during operation. At follow-up 45 patients were free from seizures. A further 15 had obtained a reduction in their seizure frequencies by at least 75%, while the remaining 10 survivors, only obtained a slight improvement or remained unchanged. There were four deaths. The operation also favourably influenced the psychiatric status, which was found closely related to relief from seizures. Prognostically favourable factors were: i) preoperative presence of a single type of seizure, ii) duration of epilepsy of less than four years, iii) operation in or before early adulthood, iv) an anterior temporal or sphenoidal electrode focus, or both, on the EEG. The prognostically unfavourable factors regarding complete relief from seizures were: i) preoperative presence of grand mal, ii) age at onset of epilepsy or of the first grand mal seizure between 5 and 19 years of age, iii) preoperative duration of epilepsy of over ten years and of grand mal of over one year. Prognostically unfavourable factors regarding psychiatric normalization were: i) preoperative presence of psychosis, ii) ictal-affective attacks or automatisms of a complex nature, iii) impairment of intellectual functions. The eventual neuropathological conclusion was that the more specific and circumscribed the histological abnormality the better the final outcome. The social rehabilitation was found to be significantly improved by operation at an early age.
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PMID:Temporal lobe epilepsy. Follow-up investigation of 74 temporal lobe resected patients. 30 43

A historical essay is presented relating concepts of epilepsy, hysteria, and "possession." The designation "hysteroepilepsy" is placed into the context of combined phenomena in individual subject instances. An association of psychotic states resembling a schizoprenic disorder is indicated as occurring in certain epileptic patients, especially some complex partial seizures (i.e., temporal lobe-psychomotor type). Phenomena of possession may appear within any of these entities. Differential diagnosis now is aided greatly by ulilization of monitoring with combined split screen television viewing and recording of the patient's behavior and the concomitant electroencephalogram. Treatment is directed both medically and toward alleviation of contributing and precipitating psychological and sociological factors.
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PMID:Epilepsy, hysteria, and "possession". A historical essay. 34 16

An analysis is presented of the findings in a group of 300 patients with head injury, aged 15 years or over at the time of the accident, who subsequently developed epileptic manifestations. Early fits (including one case of immediate onset) were found in 33% of the cases (99 patients). In contrast to post-traumatic late epilepsy (PTE), which is a manifestation of a static process, early fits are triggered off by a dynamic process (brain oedema, haemorrhage) and are a sign of cerebral irritation, but do not represent a true form of epilepsy. Early fits are related to the acute traumatic state; the time limit is flexible, but lies in the region of 4 weeks following injury. Conversion of early fits to PTE (with or without a latent interval) occurred in 72% of the cases. This percentage is higher than the average incidence quoted in the literature and presumably arises partly from the selection criteria applied in this study. The time of appearance of early fits following injury is one factor which determines the prognosis. Fits appearing on the first day carry a relatively favourable prognosis and do not proceed to PTE in 41% of the cases, whereas this percentage shrinks to 15% in the case of fits appearing from the second week onwards. Early fits are an isolated occurrence in one third of the cases; progression to PTE is less frequent in these patients than following frequent, repeated convulsions. Furthermore, the incidence of early fits is dependent, to a large extent, on traumatological and clinical factors: the combination of unconsciousness of over three hours' duration, neurological signs referable to the central nervous system, persistent organic psychotic syndrome and intracranial bleeding leads to a significantly higher incidence of early fits than unconsciousness of less than three hours' duration and absence of neurological signs in patients who, moreover, do not display features of the psychotic syndrome, and shows a greater tendency to early fits even than the combination of depressed fracture of the skull with penetration of the dura. Should, however, early fits occur in spite of a favourable assessment of the traumatological factors involved, then progression to PTE occurs in a higher percentage of such cases than in patients displaying signs of a serious import following injury. The transition to PTE is markedly higher following diffuse cerebral contusion (75% of cases) than in cases displaying signs of local contusion....
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PMID:[Epileptic manifestations following head injury (author's transl)]. 40 53

Six patients ranging in age from 42 to 69 with no prior history of seizure disorder presented an acute prolonged or intermittent confusional state, with or without psychotic symptoms, as an ictal manifestation. The EEGs demonstrated protracted generalized spike and wave discharges, but full diagnostic evaluation disclosed no evident cause for the seizures. All promptly responded to small amounts of intravenous diazepam and subsequent oral phenytoin and phenobarbital. Three of the six patients had focal spike or sharp wave discharges on EEGs recorded subsequently, suggesting that the episodes may reflect secondary generalized seizures in some cases. These cases do not fit in the classic category of petit mal status and appear to be a distinct entity.
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PMID:Acute prolonged confusion in later life as an ictal state. 41 52

In a controlled investigation of paranoid hallucinatory chronic or episodic epileptic psychoses, the social data, psychopathological symptoms and the psychological test findings (WAIS, Rorschach, object-sorting, proverb-interpretation and the Stroop test) were analyzed in order to delineate the characteristics of the psychotic syndrome and to evaluate the significance of organic etiological factors. The study comprised 45 patients with complex partial epilepsy followed by psychosis after median 23 years, and 34 control patients with the same type of epilepsy of median 30 years' duration. Among the psychotic symptoms, simple, mostly empathizable persecutory delusions and auditory hallucinations predominated. The affect tended to remain appropiate, and autistic traits were uncommon. In accordance with this finding of a relatively circumscribed psychotic personality disturbance, psychotic test indicators were infrequent in the psychological tests, the Rorschach test 28%, and the object-sorting test 18% of the cases. The poorer test performances in the WAIS and the Stroop tests, and the preponderance of organic Rorschach test signs in the psychotic group indicate that organic cerebral damage is of etiological significance in paranoid epileptic psychosis.
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PMID:Psychomotor epilepsy and psychosis. III. Social and psychological correlates. 43 72


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