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Re: Temporal Lobe Epilepsy-anyone out there?

Posted by zeke on May 18, 2001, at 21:21:39

In reply to Temporal Lobe Epilepsy-anyone out there?, posted by Mitch on May 18, 2001, at 11:46:40

I had nocturnal temporal lobe seizures when I was a teenager. But I've known a number of other people with epilepsy and with 'epileptic' personality or behavioral characteristics.

First I want to say that the psychiatric aspects of epilepsy are very controversial and not universally accepted. (It is much less frequent with modern antiseizure meds; Most people with complex partial aka temporal lobe epilespy don't have this syndrome.) So you might choose the neurologist carefully. A neuropsychiatrist or behavioral neurologist might be a better choice.

Second, an EEG could demonstrate epilepsy, but a normal EEG can't rule out epilepsy. A number of people with clear-cut clinical seizures have 'normal' EEGs. The medial temporal lobe -- where temporal lobe seizure foci usually occur -- goes deep in the brain and away from the scalp where the electrodes are placed.

You're right, people with TLE syndrome often exhibit hypergraphia (write a lot) and also verbosity -- often described as "sticky". They very often develop deep religious (or philosophical) interests and corresponding deepened morality. Sexuality is often effected, most often hyposexual but sometimes hypersexual. These folks are described as usually being "good natured" such as attempting to be unusually helpful to others. You mentioned anger: in TLE syndrome anger isn't generally so short-lived as in ADD. Anger becomes grudges for example.

Several things you mention are similar to epileptic auras -- the beginning of a seizure that may or not develop to a clinical seizure. Smells in particular. These are usually described as sickening, burning or rotting. Depersonalization or derealization is also common (but also common in anxiety or mania).

The ability of antiseizure drugs to relive TLE behavioral symptoms seems to be mixed. In some people they help. But in people with longstanding clinical seizures, as the seizures become controlled (with meds) the psych problems sometimes become worse. In such folks they often reduce seizure control for the sake of mental relief. (In fact this relationship led to the discovery of induced seizures to relieve depression: initially using insulin but then electricity -- ECT.)

Did either the Neurontin or Adderall improve the TLE related symptoms? Neurontin is used in psychiatry but it is marketed for partial epilepsy. Amphetamine (Adderall) also has antiseizure effects. In fact, it sounds like you did best (so far) when you were on Adderall. Neurontin and Adderall also are reported to have antimanic effects as well.

Another option to an ambulatory EEG would be a standard EEG with Nasopharengic or Sphenoidal leads. These are more sensitive to the medial temporal lobes.

Good luck.




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