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Episodic Dyscontrol, Rage, and Violence 

Episodic Dyscontrol, Rage, and Violence
Chapter:
Episodic Dyscontrol, Rage, and Violence
Author(s):

Roy G. Beran

DOI:
10.1093/med/9780199796793.003.0020
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date: 28 October 2021

As epileptic seizures reflect uncontrolled activity of part or all of the brain, it is not surprising that seizures may provoke episodic dyscontrol, rage or violence, consequent to discharges from an appropriate brain region, such as the amygdala. There appears an overestimate of the amount of aggressive behavior associated with epilepsy, yet it has clearly been demonstrated via telemetric patient monitoring. It may occur ictally, postictally and interictally with the majority of reports describing post-ictal aggression or post-ictal psychosis, especially with temporal lobe epilepsy. The relevant neurobiology suggests peri-amygdala pathology, possibly with left or bilateral EEG and MRI abnormalities. PET studies have demonstrated temporal and frontal hypometabolism while the involvement of various neurotransmitters has been implicated. Associated familial behavioral problems have been reported together with comorbidities and underlying brain disorders. Treatment may include use of antiepileptic medications, atypical antipsychotic agents, non-pharmacological psychotherapy and, possibly, deep brain stimulation.

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