Psychiatric Manifestations of Epilepsy: Neurophysiological and Psychopathological Models



Qaiser A. Hai

Department of Psychiatry, Faculty of Medicine, University of Garyounis, Berighazi, S.P.LA .J.

Garyounis Medical Journal Vol. 2, No.2. July 1979: 81-92


The neurophysiological basis of epilepsy and its interrelation with Psychopathology is of paramount importance, for this is the domain where it is possible to elucidate the role of cerebral dysfunction and its corresponding psychopathological manifestations. Experimental studies on the elective electrical stimulation of brain and the resulting psychiatric symptomatology has sparked a great deal of interest and provided food for thought for workers who engaged themselves in the extensive study of psychopathology in relation to epilepsy. The evidences reviewed showed that the temporal lobe epilepsy (TIE.) especially its psychomotor variant, manifests symptomatology, very akin to that of Schizopreniform Psychoses, an association far commoner in occurrence than confusional states, anxiety, depression and hysteria (usually associated with the center-encephalic and temporal lobe epilepsies). At the same time, multifactorial aetiology of Schizophreniform psychoses in a fair number of patients suffering from T.L.E. was confirmed. The studies done on the laterality effects show that the schizophrenic syndrome, commoner in males, and Manic-depressive Psychoses, commoner in females, hinge on the dominant and non-dominant differential hemispheric vulnerability respectively. Similarly it was found that an antithetical and antagonistic relationship existed between epilepsy and Psychoses, best revealed in Photo-Matrazol studies showing that this inverse relationship and it’s electrographic component, “forced normalization” (regression or disappearance of spika and wave activity in E.E.G. for the duration of psychotic episode), implies alteration in convulsive threshold. It was also hypothesized that the disturbance in the feedback control of meso-limbic depaminergic neurories might be the precise neurochemical basis of the relationship between epilepsy and schizophrenia and that Psychosis and epilepsy are the antithetical manifestations of the same underlying disturbance of neuronal excitation-inhibition, probably mediated by abnormal synaptic events. Also, the neurophysiological system activated durlag generalized seizures is a mesial-frontal-cortical-pontine-mesencephalicreticular chain, while that activated by the temporal limnbic seizure is medial-orbital frontal dorsomedial-thalmic anterior extensions; both these chains hinge at least in part on perturbed dopamine mechanisms. Studies done on the relationship between epilepsy and personality disorder show that abnormal (epileptic) lirnbie mechanisms do not appear to be causally related to personality variables and that the intellectual deterioration and the change of personality with associated psychiatric picture are multifactorial in origin, the latter also being correlated to high serum levels of some of the anticonvulsants. Similarly, the evidence shows that the high representation of epileptics in person population is an effect of the organic, social and psychological sequelae of epilepsy. It was also found that sexual deviations (e.g. fetishism and transvestism) and orgasmal dys functions are related to early onset temporal lobe dysfunction and it seems probable that in males fetishistic deviation is linked to lateralized dysfunction of the dominant hemisphere, while orgasmic pathology relates to non-dominant hemispheric dysfunction.

Keywords: Psychiatric Manifestations of Epilepsy: Neurophysiological and Psychopathological Models