Abstracts

Rationale: Grabbing is an automatism associated with epileptic seizures that is mentioned in the literature but without any quantification. The potential forensic implications of this seizure manifestation are not well-studied. Methods: We reviewed the clinical database for the University of Colorado Epilepsy Center, a tertiary care referral center, searching for patients with grabbing automatisms and subsequent legal consequences. Results: Case one: A 44-year-old man developed cryptogenic seizures in elementary school. According to witnesses, he would wander at night into his mother's room and grab her in a nonspecific way, often hugging her. He would be unresponsive with lip smacking. At age 31, he came to medical attention after a secondarily generalized convulsion and was started on phenytoin. Work up included left temporal spikes on EEG and a normal MRI. His legal problem occurred at age 41 years when he was watching television on a sofa with a friend's 10 year old daughter. He allegedly began groping her; was unresponsive and she easily escaped. He did not pursue her and has no memory of the event. He had no previous criminal record. He was found guilty of sexual assault on a minor. Case two: A 40-year-old man began having seizures at the age of 34 following a closed head injury. He initially presented with a generalized tonic-clonic seizure. His seizures are believed to be right temporal onset complex partial seizures. He has a normal brain MRI scan. He averages about one seizure every 10 days. His seizures are stereotyped with chewing behaviors and an urge to wander and he frequently will grab, usually the arm of a bystander. "The event" occurred while he was in a shopping mall with his girlfriend. He had one of his typical complex partial seizures and grabbed the arm of a woman who was a stranger. The shopping mall security and local police became involved. He was first transported to a hospital where he was evaluated and released. Criminal charges have been filed against him. Conclusions: We report two cases of patients who have temporal lobe onset complex partial seizures. Both of them had seizure-related automatisms involving grabbing people which resulted in legal complications. Defining grabbing as a clear ictal behavior may help mitigate possible legal consequences for future patients.