Temporal Lobe Epilepsy and Explosive Behavior

Matthew Stubblefield drskip at ix.netcom.com
Fri Mar 14 05:42:43 EST 1997

In <5g2jh7$ffk at dfw-ixnews10.ix.netcom.com> flefever at ix.netcom.com(F.
Frank LeFever) writes: 
>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
>>and limited force used to support flight).  Always happens after
>>incidents.  Child reports clear recall of events but does not PLAN
>Few of us PLAN impulsive acts in the heat of emotion.
>His remembering events tends to argue against the flight being an
>event, doesn't it?
>> Expresses remorse for results of behavior but is distant from act
>Remorse for outcomes of impulsive acts is common among normal people
>well as among disinhibited "frontal" cases, to name just two
>alternative examples.
>Not sure what is meant by "distant from act itself"--reluctant to
>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
>>-- 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
>>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
>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)
>>Sam Leven, Ph. D.
The idea of functional brain imaging is a good one, despite an
abundance of good clinical studies to support this.  In my clinic
practice, we see frequently the presence of left temporal perfusion
abnormalities associated with violent or otherwise explosive kids. 
More purely cingulate, basal ganglia, or pre-frontal lobe perfusion
abnormalities, which may also be associated with erraticness or
explosiveness would lead us away from anti-convulsant trials. 

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