Affective Seizures

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Any emotion can be expressed during the course of an epileptic seizure (2.2.2.1). Irritability, anxiety, and anger can occur from amygdalar seizures or stimulation (46,48). Fear is commonly a component of hippocam-pal seizures (90). It is often without content and thus takes on the perception of unreality (91). An affectless expression of fear can occur with cingulate seizures, as can a feeling of happiness (64,71). Auras may involve the sudden onset of overwhelming fear without dependence on the patient's mood or thoughts (92), and ictal episodes of isolated fear may be confused with psychiatric illnesses of paranoia or panic disorder.

Case Study #11. A 55-year-old man was noted to have a change in mood over 3 years, from placidity to increasing spells of irritability. He was increasingly suspicious, with brief episodes of inexplicable severe fright. He had short episodes of unnatural aggressiveness lasting from a few seconds to half a minute. An EEG showed high-voltage 2 to 3 per-second waves in the right temporal area. An inoperable glioma was found in the right temporal lobe (93).

Gelastic (laughing) or dacrystic (crying) epileptic seizures can occur; even in the same individual.

Case Study #12. A 35-year-old had epileptic seizures since the age of 5 years. Her current seizures consisted of simple laughter, often preceded by a feeling of euphoria. These did not respond to high doses of several antiepileptic drugs, and routine EEGs were normal. Video-EEG recorded numerous episodes of laughter and/or crying accompanied by midline to right tempor-parietal region rhythmic theta activity. She was able to speak during the events but was amnestic afterwards.

These affective epileptic seizures may emanate from the frontal lobe or temporal lobe, but the gelastic seizures are best known in association with hypothalamic hamartomas, which appear to be the seizure source, possibly through connections to the anterior thalamus and on to the cingulate cortex (94-95).

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