Temporal lobe epilepsy: neurological and behavioral aspects.

Abstract

It is perhaps fair to say that in no other disorder do the disciplines of neurology and psychiatry overlap so extensively as in epilepsy. Despite this, lay and at times professional organizations have mounted well-intended but unfortunate (for the patient) propaganda campaigns to deny this special association. As a consequence, the serious psychiatric complications of epilepsy have often gone unrecognized by the internist or neurologist and have generally been of little interest to the psychia­ trist. A better understanding of this association is of paramount importance if we are to provide these patients with comprehensive treatment for a complex disorder. Although the prevalence of psychical aberrations in epileptics has been recog­ nized since ancient times (1), it was not until the advent of modern electroencephalo­ graphic (EEG) technology (2) that a special association of severe psychiatric disorders with the psychomotor (temporal lobe) form of epilepsy was documented. Interest in this association of epilepsy and in particular temporal lobe epilepsy (TLE) with various forms of behavioral disorder has produced a rich but confusing and often contradictory literature. In part this is due to the loose nosology character­ izing much of the psychiatric literature and also because of the varying neurological and EEG criteria chosen for making the diagnosis of TLE. Diagnostic difficulties arise on the one hand from the protean manifestations which characterize the clinical seizures and on the other from the fact that electrical discharges deep in the temporal lobe frequently go undetected in the scalp-recorded EEG. For our purposes, the individual temporal lobe seizures of TLE may be defined operationally as focal seizures produced by discharging lesions situated in or [secondarily] projecting to the temporal lobes (3). It would undoubtedly be more correct to speak of limbic rather than temporal lobe epilepsy since many clinical features appear to depend upon the propagation of the discharges from the temporal