Sexual Automatisms

Sexual automatisms were not recognized as an epileptic phenomen until recently (39). They may consist of pelvic thrusting and genital manipulation. Because of their sexual content, they are often mistaken for psychiatric disease and, in fact, in nonepileptic or psychogenic seizures, pelvic thrusting is frequently observed. However, epileptic sexual automatisms have a very stereotyped appearance, and other epileptic motor manifestations, such as manual automatisms or clonic activity, are usually associated with sexual behavior. Seizures are relatively brief. Epileptic sexual automatisms are thought to originate in the prefrontal cortex and are associated with frontodorsal, frontopolar, or orbitofrontal seizure onset (39).

It has not been systematically examined whether sexual automatisms are associated with a postictally increased prolactin level. Prolactin seems to be elevated after generalized convulsions and 60% of complex partial seizures (40). A high frequency of falsely positive elevated prolactin level occurs, therefore the use of pro-lactin as a measure to distinguish nonepileptic from epileptic seizures is limited.

Sexual automatisms differ from orgasmic epilepsy, where a patient may have an orgasmic sensation at the onset of a seizure. These sensations seem to originate in the right hemisphere (41) and were previously localized to the right parietal parasagittal area (42).

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