Abstracts

Ictal aggression is extremely rare. We report the video EEG of two cases of aggressive behavior occurring during temporal lobe seizures. Case 1 involved a 20 year old man with a 3 year history of poorly controlled complex partial seizures. His MRI and neurological exam were normal. Interictal EEG revealed frequent right temporal sharp waves. Several seizures were captured on video EEG during which the patient exhibited destructive manifestations, improper language, and semi-purposefully striking and throwing objects. In one unprovoked typical event he struck a wall and attempted to strike his father. His language during this consisted of swearing and inappropriate words. Electrographically, rhythmic lateralized theta activity seen best over the anterior right temporal electrodes was present and began 7 seconds prior to the event. This progressed into higher frequency activity with superimposed spikes and poly-spikes over a 2 minute period.
Case 2 involved a 39 year old man with a 4 year history of complex partial seizures and right temporal lobe tumor. Video EEG monitoring revealed the patient getting out of bed, turning toward his wife and motioning with his arms as if to shoot a bow and arrow at her while he makes a shooting noise. He then moves in towards her and appears to strangle her briefly. She cried out and he stepped back with a dazed look over his face. Electrographically, the seizure began with rhythmic theta activity over the right temporal electrodes, which gradually increased in amplitude and sharpness. Both patients were amnestic of the events. In the second case the behavior was not the patient[apos]s typical event, having been induced by medication withdrawal. Ictal aggression is extremely rare, but does occur with temporal lobe seizures and probably can lead to injury to the patient or others. Medication withdrawal may lead to a new seizure type for an individual patient, including ictal aggressive behavior.