Abstracts

Rationale: To describe a case of hypersexuality following right temporal lesionectomy for temporal lobe epilepsy.Methods: We describe a 31 year-old right-handed female with experiential auras and focal dyscognitive seizures. Spells started the year prior to evaluation and increased from occasional to daily. Levetiracetam (LEV) afforded modest improvement. Brain MRI showed a tubular enhancing structure in the right superior temporal gyrus and hemosiderin deposition consistent with a cryptic vascular malformation. Brain MRA was unremarkable. Sleep deprived EEG showed right temporal sharp waves. Microsurgical excision of the vascular malformation ensued. She reported symptoms of depression 3 months post-op. Escitalopram was prescribed, but not filled. She discontinued LEV on her own after which déjà vu feelings commenced. Oxcarbazepine (OXC) stopped auras. She later endorsed anxiety. Four months post-op she reported empathy and sexual arousal elicited by scents like cologne, deodorant, or cigarette smoke. A 72-hour ambulatory EEG showed no interictal discharges. Sexual intercourse was captured during recording, but no ictal activity noted. Eight months post-op patient stated “I’ve become more and more sexual.” She also reported impulsivity, making sexual advances to random men, putting her name on Craigslist, and handing out her number to strangers. She reported feeling attracted to males and females. At work she often excused herself to go masturbate in the washroom. Escitalopram and psychotherapy were started with a 50% improvement in sexual urges, although she still masturbated 3 times a day. She remained seizure free on OXC 8 months post-op.Results: The subject is a female with remote depression and no risk factors for epilepsy. She is a Social worker, married with 2 young children. Focal dyscognitive seizures without secondary generalization commenced at age 30. EEG showed right temporal sharp waves. MRI revealed a vascular malformation in the right superior temporal gyrus. Microsurgical excision took place 17 months after the onset of seizures. Depression and anxiety ensued 3 months post-op. At 4 months post-op patient made reference to sexual arousal from certain scents. By 8 months post-op the patient had engaged in multiple sexual encounters with strangers, and frequent masturbation. An SSRI and psychotherapy resulted in improvement in patient’s sexual proclivities. Patient remains seizure.Conclusions: This case illustrates the dramatic changes in sexual behavior rarely seen after temporal lobe resection. Sexual dysfunction in patients with temporal lobe epilepsy is well recognized (Morrell el al. 1996). However, less is known about hypersexuality following temporal lobe resection. Bladin reported 46% increase in sexual drive and interest in a group of 84 seizure free patients after temporal lobe resection. Baird et al in their case series of 7 patients with hypersexuality after temporal resection proposed 3 potential mechanisms: 1. Neurophysiological changes following seizure cessation. 2. Abnormalities in the unoperated temporal lobe, and 3. So-called ""burden of normality.”