Understanding and Preventing Violence, Volume 2: Biobehavioral Influences (1994)
Chapter: Aggression as an Epileptic Equivalent
of patients who exhibit violent behavior can be rationalized as the equivalent of removal of a seizure focus. Surgical treatment of intractable seizures has been a successful therapy for at least 40 years (Penfield and Jasper, 1954).
Aggression as an Epileptic Equivalent
A review of the literature published during 1974–1989 indicates that there has been a substantial emphasis on the possible relation between seizure disorders and aggressive behavior. Twelve studies or literature reviews have examined this question; of these, seven concluded, on the basis of the review either of clinical case material or of the literature, that there is an association in patients between the occurrence of seizure disorders and the likelihood of aggressive or violent behavior (Weiger and Bear, 1988; Lewis et al., 1983; Bear and Fedio, 1977; Bear et al., 1981; Devinsky and Bear, 1984; Perini, 1986; Engel et al., 1986). It should be noted that four of these studies are based on the work or views of Bear (Weiger and Bear, 1988; Bear and Fedio, 1977; Bear et al., 1981; Devinsky and Bear, 1984), for whom the greater aggressiveness of epileptic patients (specifically those with temporal lobe foci of abnormality) is an example of the enhanced emotional responsivity that characterizes behavioral transactions in such persons. This, in turn, is attributed by Bear to the sensitization of the limbic system and greater autonomic responsivity resulting from the epileptogenic focus (Bear et al., 1981).
Three additional references concluded that although there may indeed be an association between epilepsy and violence, this is a spurious connection, related to other factors (Hermann, 1982; Virkkunen, 1983; Stone, 1984). Among these other factors are impaired cognition (Hermann, 1982) and an angry reaction borne out of despair over the incurable nature of the disorder (Stone, 1984). Further, Virkkunen concludes that aggression in epileptics is a "multifactorially determined … phenomenon" (Virkkunen, 1983:647).
Two studies concluded that there is no relation between epilepsy and violence that cannot be accounted for in terms of the socioeconomic class of the patients studied (i.e., more assaultive behavior is associated with lower socioeconomic class; Tardiff and Sweillam, 1980:Table 3; Treiman, 1986:Table 5). The study by Tardiff and Sweillam (1980) is particularly impressive since it is based on a sample of more than 9,000 patients admitted to psychiatric hospitals in a one-year period.
