Aggression in temporal lobe epilepsy and limbic psychotic trigger reaction implicating vagus kindling of hippocampus/amygdala (in sinus abnormalites on MRIs)

Abstract

Five aspects associated with potentially aggressive partial limbic seizures are interrelated: (1) Five out of six unselected (consecutively referred) White, male out-of-character aggressive felons (mean age 33) had histories of recurrent nasopharyngeal infections, four with congruent MRIs, two of these MRIs also showed cortical atrophy, three men had histories of various seizures, and one scalp EEG was “congruent with seizures in the temporal regions.” All men had histories of head injuries. The diagnoses of their bizarre acts during a brief psychosis were partial limbic seizures in an “exhibitionist” with temporal lobe epilepsy (TLE) and proposed limbic psychotic trigger reaction (LPTR) in four “murderers”, based on 13 specific symptoms and signs. (2) The men's nasopharyngeal (medical) conditions are hypothesized to be associated with intermittent mild stimulation of the vagus nerve. Supportive evidence shows that (3) experimental vagus stimulation has the most excitatory impact on hippocampus and amygdala, which are also (4) the most susceptible to limbic seizure kindling (by intermittent subthreshold stimuli). (5) even by contrast, high-voltage energy level and frequently applied vagus nerve stimulation (VNS), which is used as an antiepileptic treatment; however, VNS has elicited seizures in some patients.