Temporal Lobe Epilepsy and Explosive Behavior

F. Frank LeFever flefever at ix.netcom.com
Mon Mar 10 22:28:39 EST 1997


I'll insert a few comments below.

Frank LeFever
New York Neuropsychology Group


In <19970309135701.IAA16129 at ladder01.news.aol.com> samnets at aol.com
(SamNets) writes: 
>
>Male, 10, presents with sudden, automatic explosive episodes (running
away
>and limited force used to support flight).  Always happens after shame
>incidents.  Child reports clear recall of events but does not PLAN
flight.

Few of us PLAN impulsive acts in the heat of emotion.
His remembering events tends to argue against the flight being an ictal
event, doesn't it?


> Expresses remorse for results of behavior but is distant from act
itself.

Remorse for outcomes of impulsive acts is common among normal people as
well as among disinhibited "frontal" cases, to name just two
alternative examples.

Not sure what is meant by "distant from act itself"--reluctant to admit
responsibility?  Again, a common human trait.  FEELING distant?  If to
the extreme of being "depersonalization" or "dissociation", could be
cited in support of a "TLE" hypothesis; otherwise--weak!

>Otherwise, child may have right hemisphere deficit. 

If true, MIGHT include poor social perception/skills, making him
vulnerable to social mishaps and misunderstanding, poorly equipped to
deal gracefully with "shame", etc., thus leaving panicky flight the
only alternative...

 High IQ (130+
>Verbal), large gaps on Halstead-Reitan (107 Performance, 85
Visuo/Spatial
>-- 4 std. dev.).

I consider the Halstead-Reitan a poor resource for drawing such fine
distinctions; have you a repertoire of tests for follow-up exploration?


>Does this profile seem to match TLE with LD? 

Why don't you ask Ralph Reitan if there is a Halstead-Reitan profile
for TLE...

As for LD--what academic tests have you done to establish LD?  Many
studies show high incidence of "soft signs" etc., etc. among LD
students, but (for ex.) Steve Mattis et al. many years ago published a
comparison of children with "neuro" signs with LD and children with
"neuro" signs and no LD...  If LD is established, neuropsych testing
might help to clarify functional deficits underlying it, but do not
assume LD just from neuropsych "profiles".


 Outside of sleep-deprived
>EEG, what other measures ought to be applied 

None.  Try not too stigmatize him further.

(clean MRI, apparently; 2d
>ordered).

Why?  Not likely to find TLE site unless lesional.  If really keen on
TLE idea, metabolic study, looking for hypoperfusion, hypometabolism,
might be more fruitful (e.g. SPECT, PET).


>Thanks for help.

I don't recognize your name from INS (but don't have directory at
hand): member of NAN? (Halstead-Reitan suggests the latter).  Besides
this resource, attendance at their meetings helps network for such
questions.  Also, Loring has a neuropsych web site (check with INS)

Frank


>Sam Leven, Ph. D.




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