When you hear the word epilepsy, what comes to mind? Hollywood usually shows us the convulsions of the grand mal seizure, but the seizures caused by temporal lobe epilepsy are more common, if less obvious.
During a temporal lobe seizure, a person can be overcome by intense emotions, vivid memories-even sensory hallucinations. And accumulating evidence suggests that people with epilepsy are prone to developing depression and other mood disorders, while people with a history of depression develop epilepsy four to seven times more often than average.
Fortunately, the seizures caused by temporal lobe epilepsy can be controlled by an array of medications, many of which also improve mood. If the medications don’t work, and if the brain lesion causing the seizures can be located, it can be surgically removed, often leaving the patient both seizure- and depression-free.
THE SEAT OF EMOTION
The temporal lobes, which ride the brain like saddlebags, each contain an almond-shaped structure called the amygdala that generates an emotional reaction to our sensory perceptions. Presented with the smell of smoke, the amygdala may generate fear, until we realize that the smoke is coming from a neighbor’s grill. Then, at the thought of juicy hamburgers, the amygdala may generate excitement.
When we see or hear something, the amygdala tells us if it’s frightening or sexually arousing or whatever, says David Bear, M.D., a neurologist in the department of psychiatry at the University of Massachusetts. It adds the emotional charge to our experiences. When the amygdala is removed from both hemispheres of an animal’s brain, the animal doesn’t show fear, it doesn’t become aggressive, and it may try to mount animals of both sexes. It doesn’t even do a good job of determining what’s good to eat! A monkey without an amygdala may try to bite a piece of metal.
Temporal lobe epilepsy often creates the opposite situation: the amygdala generates too much emotion, which can result in mood disorders.
EPILEPSY AND PERSONALITY
What did Joan of Arc and Fyodor Dostoyevsky have in common? They both showed signs of Geschwind syndrome, a group of personality traits that seem to result from the epileptic storms that excite the temporal lobes.
The most common traits of Geschwind syndrome-excessive writing or hypergraphia, intense interest in religion, a clingy personality, aggression, and altered sexuality-are not inherently abnormal. What one person considers hyperreligious behavior another might consider admirable piety. A sticky personality can be viewed as devotion to friends. Hypergraphia can propel a writer to literary achievement, as in the case of Dostoyevsky. Aggression can be seen as a sign of intense passion, and loss of interest in sex as high-minded celibacy.
In addition, the intensity of emotion caused by temporal lobe epilepsy can be captivating. For religious leaders such as Joan of Arc, this passion may have deepened their spiritual feelings and attracted followers.
People with temporal lobe epilepsy are like everyone else, only more so, says Eve LaPlante, author ofSeized, a fascinating look at how temporal lobe seizures have affected the lives of the famous, the infamous, and the ordinary.
DEPRESSION AND EPILEPSY
Depression affects about 20 to 40 percent of people with temporal lobe epilepsy, compared to 3 to 7 percent in the general population. This depression often yields to the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which are the first choice of treatment. Anti-epileptic drugs can help too.
The dance between epilepsy and depression is complex: People with epilepsy often can’t drive or hold a job, problems that can interfere with their quality of life and lead to depression. Still, the interplay suggests that a common underlying problem promotes both conditions. Magnetic resonance imaging (MRI) often shows that the hippocampus in the temporal lobe of a depressed person shrinks, along with areas farther forward in the brain. These changes are common in people with temporal lobe epilepsy as well.
You see the same changes in people with primary mood disorders without temporal lobe epilepsy as you see in people with temporal lobe epilepsy, says Andres M. Kanner, M.D., director of the electroencephalography (EEG) lab at the Rush Epilepsy Center in Chicago.
This means that some medications work for both. Antiepileptics such as lamotrigine (Lamictal) and valproic acid (Depakote, Depakene) are also used to treat bipolar disorder in people without epilepsy, says Brien Smith, M.D., medical director of the Comprehensive Epilepsy Program at Henry Ford Hospital in Detroit.
One link between temporal lobe epilepsy and mood disorders is the neurotransmitter serotonin. Seizures can be induced in animals by sending electricity into their brain; subsequent seizures then become much easier to induce due to a process known as kindling. But if these animals receive antidepressants that boost their level of serotonin, the kindling stops, and seizures become much more difficult to induce.
This suggests there’s a serotonin dysfunction in both temporal lobe epilepsy and in mood disorders, says Kanner.
I believe this reading to very interesting and also very suitable to what our studies are about these days. We are studying at Psychiatry different mental disorders and we will be studying in a few months the neurological diseases. At this entry we can see how a pathoneurological status can influence in the mental behavior of the person, how the organic sickness of the patient can actually determine the patient personality. In this particular case it is show how epilepsy it is often match to a specific kind of personality which clinicians described as “a positive personality change among patients with chronic temporal lobe epilepsy”. It is the Epilepsy Personality Syndrome or Geschwind Syndrome. Besides the scientific point of view, History has passes us some stories about well-known personalities. There is a general belief in how part of their greatness was due to their supposed epilepsy illness. This is not a medical or scientific fact, but as a curious detail here are some of them: Julius Caesar, Alexander the Great, Napoleon, Vladimir Lenin, Dostoyevsky, Tolstoy, …
In short just to say that I find, among other also interesting elements of the epilepsy , this subject about a superior-special personality, rather riveting.
ANA NARBONA DIEZ