AGGRESSIVE ATTACKS FOLLOWING SEIZURES: PATTERNS DETECTED
Some normally nonviolent in-dividuals exhibit bizarre and
frightening aggression following epileptic seizures. In an
attempt to learn more about what prompts this behavior, M.
Elizabeth Gerard and colleagues combed their database of 1,300
patients and identified six who experienced post-seizure
aggressive episodes. Among the patients they studied:
The six patients they studied, Gerard et al. say, showed no
consistent pattern of age, seizure cause, or right-left seizure
focus. However, some common patterns emerged. All of the patients
were male, and the researchers note that in all cases, "the
episodes of post-ictal aggression were not isolated events, but
recurred repeatedly," with symptoms unique to each patient. In
addition, the aggressive episodes tended to follow clusters of
seizures, rather than single seizures. Furthermore, all of the
patients had intractable epilepsy, and in all cases, aggressive
episodes occurred within three days of the last seizure.
One 42-year-old man, an auto mechanic, had suffered seizures
since an episode of meningitis in early childhood. The man's
behavior is normal except during periods of increased seizure
activity. "During these times," the researchers say, "he exhibits
a post-ictal [post-seizure] psychotic state characterized by
religious preoccupations, hypersexuality, auditory
hallucinations, occasional visual hallucinations of God, and
paranoid delusions." He has committed a number of violent acts
during these phases, including attempting to stab his sister.
"The psychosis typically begins 6 to 24 hours after the last
seizure," Gerard et al. say, "and lasts from several hours to
- One 32-year-old man, who suffered from seizures beginning in
childhood, developed post-seizure aggression in his teenage years
following experimentation with illegal drugs. His aggressive
behaviors typically lasted from 20 minutes to one hour. "If the
patient's mother was in the vicinity," the researchers say, "he
would actively seek her out, and display both physical and verbal
aggressive behavior toward her alone."
- A 55-year-old military veteran, with seizures of unknown
origin, experienced several post-seizure aggressive episodes so
violent he required hospitalization. Following the seizures, the
researchers say, the man believed that people wearing red
represented the devil and would attempt to take off their
clothes, fighting them if they resisted. "He has attacked family
members with knives and broken bottles," the researchers say,
"and has attempted to `baptize' his own child by immersing her in
a swimming pool."
The researchers note that five of the patients had no memory of
their aggressive acts, and that "all of the patients were
remorseful about their behaviors" following attacks. Four of the
patients exhibited no mental disorders between attacks, while two
had psychiatric disorders.
Gerard and colleagues say that post-seizure aggression, while
rare, "appears to be a true clinical entity with several
consistently observed manifestations." Similar behavior, they
note, can be induced in rats with kindled seizures in the
"Subacute postictal aggression," M. Elizabeth Gerard, Mark C.
Spitz, John A. Towbin, and Dianne Shantz, Neurology, Vol. 50, No.
2, February 1998, pp. 384-388. Address: Mark C. Spitz, University
of Colorado Health Sciences Center, 4200 East Ninth Avenue, B-
150, Denver, CO 80262.