Abstract
Frontal lobe seizures may manifest bizarre behaviors such as thrashing, kicking, genital manipulation, unusual facial expressions, and articulate vocalizations.1 Aggressive and violent behaviors have also been associated with epilepsy, especially temporal or frontal lobe seizures.2 However, this behavior is rare in the ictal state. Aggressive ictal behavior is generally believed to not be goal directed. Interactive behavior with the ability to respond to visual and verbal stimuli is also rare in complex partial seizures. We report the case of a patient with seizures manifesting with interactive directed aggressive behaviors. ### Case report. An 18-year-old right handed man was brought in by his mother for a second opinion regarding possible seizures after being suspended from junior college for threatening to shoot his teacher and classmates. The patient had been born prematurely and had a grade 1 periventricular hemorrhage. Motor milestones were delayed by 4 months, but development was otherwise normal. He had a generalized tonic-clonic seizure at age 9, and subsequently had complex partial seizures characterized by confusion, hand automatisms, and drawing up of the legs. These seizures resolved on carbamazepine, which was discontinued after 2 years. At age 15, the patient started having stereotyped episodes characterized by a feeling of “stage fright” and followed by verbal profanities and using his hand as a stylized gun to …
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