Cerebral birth anoxia, seizures and Kluver-Bucy syndrome: some observations

Abstract

Kluver-Bucy syndrome (KBS) includes increased oral exploration, placidity, indiscriminate hypersexuality and altered dietary habits, reported to develop following insult to temporal lobes. Psychic blindness (inability to recognize familiar objects) and hypermetamorphosis (strong tendency to react to visual stimulus) are other constituents of this neurobehavioral syndrome. We encountered 12 children with features of KBS among cases of delayed mental and motor milestones following cerebral birth anoxia consequent to hypoxic-ischemic encephalopathy. Period of the study was 11 years (January 1994-June 2004). Diagnosis of hypoxic-ischemic encephalopathy was based on birth records, pediatricians' report, history provided by mother or relatives, clinical and radiological features. Their age ranged between 6 and 14 years. Development of hyperorality, sexual hyperactivity and abnormal behavior suggested the presence of KBS in them. Hyperorality and abnormal behavior were common manifestations in all patients. Hyperorality was in form of an attempt to put non-edible substances in mouth, while abnormal behavior manifested as hostility, irritability or placidity. Hypersexuality was evident in seven children and presented as fondling, holding or rubbing the genitals along with paroxysmal pelvic thrusting. Seizures were present in eight patients. In five of these, they were well-controlled (more than 60% decline in frequency), with improvement in behavior in three of them, following control of seizures. In other patients, behavior was unaltered. It appears that KBS may be more common than was suspected previously in children of cerebral birth anoxia consequent to hypoxic ischemic encephalopathy. Though it may manifest with a wide clinical spectrum, hyperorality is its commonest constituent. Seizures are commonly associated and their control may help in improving the behavioral disorder.