Neurology Now Magazine

Neurology Now

March/April 2007

 Volume 3(2)

 

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.

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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

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7 respuestas a Neurology Now Magazine

  1. Belén Leal Mora dijo:

    I feel the article our friend Ana has found is really interesting because of the importance of this complex neurological disorder called “epilepsy” and the link it has with our studies in this four-month period. The problem is that we cannot thoroughly speak about this matter due to we still have not start studying Neurology as a subject, but I consider it really useful for establishing a first contact with this intellectual matter, so I am going to speak a little bit about it.
    First of all, as the author of the text has explained, people who suffer from epilepsy are susceptible to develop depression and other mood disorders, and as far as researchers have shown, the almond-shaped groups of nuclei located deep within the medical temporal lobes of the brain in complex vertebrates, including humans are the main responsibles. These anatomical structures, considered part of the lymbic system, known as the “amygdalae” are shown in research to perform a primary role in the processing of memory and emotional reactions.
    In complex vertebrates, including humans, the amygdalae perform primary roles in the formation and storage of memories associated with emotional events. Research indicates that, during fear conditioning, sensory stimuli reach the basolateral complexes of the amygdalae, particularly the lateral nuclei, where they form associations with memories of the stimuli. The association between stimuli and the aversive events they predict may be mediated by long-term potentiation, a sustained enhancement of signalling between affected neurons.
    With advances in neuroimaging technology such as MRI, neuroscientists have made significant findings concerning the amygdala in the human brain. A variety of data shows the amygdala has a substantial role in mental states, and is related to many psychological disorders. Some studies have shown children with anxiety disorders tend to have a smaller left amygdala. In the majority of the cases, there was an association between an increase in the size of the left amygdala with the use of antidepressant medication or psychotherapy. The left amygdala has been linked to social anxiety, obsessive and compulsive disorders, and post traumatic stress, as well as more broadly to separation and general anxiety.
    Rearchers have observed hyperactivity in the amygdala when patients have shown threatening faces or have confronted with frightening situations. Patients with more severe social phobia have shown a correlation with increased response in the amygdala. Similarly, depressed patients have shown exaggerated left amygdala activity when interpreting emotions for all faces, and especially for fearful faces. In addition, as it is written in the article, temporal lobe epilepsy often generates too much emotion, which can result in mood disorders, especially in depression. Interestingly, this hyperactivity have been normalized when patients go on antidepressant, primarily on selective serotonine reuptake inhibitors. Moreover, anti-epileptic drugs can help, and if medication don’t work, and if the brain lesion causing the seizulres can be located, patients can have an operation to solve both seizure and depression problem.
    To conclude with this, as far as I am concerned, there is an anatomical such as a serotonine dysfunction in both temporal lobe epilepsy and in mood disorders.

  2. MAIALEN IÑIGUEZ DE HEREDIA dijo:

    The autor of this article is trying to tell us that depresion is the most frecuent psychiatric comorbility in epilepsy. But yet, it remains under-recognized and untreated in some cases. Depression in patients with epilepsy is a serious medical and social problem since it afflicts almost one half of all patients treated in epilepsy referral centers. It seems to be correlated with certain types of epileptic seizures, with high frequency of seizures, suboptimal pharmacologic treatment and lack of occupational and social activity.

    As Ana has explained, we have been studying Psychiatry and I have been reading other articles related with this item because I find this subject very interesting. I have found one, in which encourage psychiatrists to consider ECT as a safe and efficacious option in epileptic patients with major depressive disorder. I want to remembre electroconvulsive therapy (ECT) is a very effective and generally safe treatment for depression and some other health conditions that uses electricity to trigger a seizure.

    And now if you want we can debate about this treatment, or any idea it comes to your mind.

  3. SANDRA dijo:

    I consider this article is quite interesting because it shows us how the epilepsy develops and which are the causes and the consequences of suffering this illness. We still don’t know too much about this item, because we only have done psychiatry subject and not neurology subject yet, but both subjects have things in common.

    People with epilepsy can develop a depression due to their underlying disease. But although epilepsy can promote negative effects, it is also known that there were some people who take advantage of it to become important and famous. Maybe these people if they hadn’t had epilepsy, they wouldn’t have become anyone or have done anything important. So this is something that has impressed me.

    Obviously epilepsy is a disease and as such, it must be treated, but it’s curious how an illness can be something “positive” for some people.

    Answering Maialen’s question, I think that ECT is a good treatment for some illnesses. Although there have been too many discrepancies and disputes about that, it is known and tested that some specific illnesses can take profit of the use of that treatment. So, as long as the ECT can assure the improvement of the status of the patient, I think there is no problem to use it.

    SANDRA SORIANO SÁNCHEZ

  4. MARTA SOJO ELIAS dijo:

    I find this article quite interesting, as we have studied Psychiatry we can understand it even better.

    As Maialen says and as we have studied, ECT is used in depressions and other mental disorders like psicosis or schizophrenias. It’s a therapy with great results but we can not forget about it’s side effects. Some of those side effects are headaches, confusion, fractures, amnesia and memory impairment.

    So I think it’s a great treatment but we have to take into account about the side effects it has, cause every patient is different from the other, and what works with one, maybe don’t work with another.

    As it is a quite aggresive technique I think it’s better to begin treating patients with antidepressants such as SSRIs or antiepileptics such as valproic acid wich are less injurious and if with this ones is not enough, then we will think of ECT.

  5. Carolina Pérez Benito dijo:

    This article is very interesting, especially because recently we have studied the subject of psychiatry. Although tomorrow will not be psychiatrist, I think it is a medical specialty interesting, very necessary, which carries risks, but also very grateful.
    I would come to understand how small destabilization, large amounts or small amounts of neurotransmitters or brain structural problems affect personality, way of thinking, acting, relating … people.
    The mind is the eternal unknown. We have much knowledge about cardiology, nephrology but the knowledge of the mind are scarce.

    In patients with neurological problems, we believe that what happens is a problem of destabilization of neurotransmitters. With new Electroconvulsive therapy, that destabilization of neurotransmitters stabilizes. Unfortunately, the therapy is effective for a definite time. Currently there is no therapy found fixed. The drugs seem to help these decompensation but have many side effects and need a consistent pattern. The TEC apply under very stringent conditions, in patients with severe depression who do not respond to treatment with medication. Involves the application of an electric shock to the head of about 40 seconds. Apply two or three times per week to a maximum of 12 sessions.

    In the excellent film ‘One Flew Over the Cuckoo’s Nest’, Milos Forman, Jack Nicholson plays a character who is detained in a psychiatric hospital. This film caused a great fear of this therapy. Today much has changed electroconvulsive therapy and patients do not suffer at all. Side effects such as depression or temporary memory loss, usually solve several months after completion of treatment.

    From my point of view, the benefits of ECT are high compared to the adverse effects it causes. Mental illness is unknown, but like any other illness must be treated, study and research as possible.

  6. IRIS LUENGO ARROYO dijo:

    I heard about some kind of epileptic personality before. I didn’t know very much about it though. Because of that, I consider this article highly interesting , specially the part of Geschwind’s Syndrome.
    It is surprising how a real disease can affect a person’s behaviour in terms of emotions, sexuality or religiosity. Even more, when we discover that great historic personalities have suffered that kind of condition. And as a result, he have could enjoy their master pieces, such as music or art.
    For instance, it is thought that Vincent van Gogh suffered from depression, schizophrenia, or digitalis (a heart medication) toxicity. Others point that van Gogh was diagnosed with epilepsy. Van Gogh showed many traits of Geschwind’s Syndrome.
    In relation to ETC and what my classmates have said. I personally think that is a very effective treatment when patients require it. We must don’t forget about side effects, but neither stop using it because of them when indicated.

  7. MANUELA dijo:

    This article has shocked me, not due to his scientific arguments about how the seizure of the temporal lobe epilepsy can caused mood disorder as aggressive personality, the lack of fear if the amygdale is removed, the sexual disorders or the abnormal experiences that can be caused by the Geschwind syndrome.
    What has really surprised me is the historical influence that this mental disorder carries on. I knew that Joan of Arc affirmed to hear the God’s voice leading her to the war, but I didn’t conceive it as a manifestation of neurotransmitters dysfunctions. Neither did I suspect about Napoleon. Those two historical personalities had been seeing as the article refers, as stronger characters captivating.
    On the other hand, what I would like to talk about is the restrictions involved in this disorder. The text tells us about the difficulties of the people with epilepsy in their current life, as driving or to hold a job, and the importance of receiving a good treatment. As we have studied the ECT, is a safe and effective technique, which can help those patients to improve their quality of life.

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