1/16. Mesial temporal lobe epilepsy versus amygdalar epilepsy: late seizure recurrence after initially successful amygdalotomy and regained seizure control following hippocampectomy.We summarise the concept of mesial temporal lobe epilepsy and the pros and cons in order to define amygdala epilepsy. We present a patient with stereotactically proven right amygdalar seizure onset, associated with fear and vegetative autonomic signs and symptoms as the most prominent clinical ictal features. Following a right stereotactic amygdalotomy, the patient experienced an 11-year seizure-free period. Similar, but not identical, semeiology of complex partial seizures then recurred. A right-sided selective hippocampectomy and excision of the previously lesioned amygdala was performed. Except for 2 complex partial seizures associated with withdrawal of antiepileptic drugs, the patient remained seizure-free 9.5 years. This case underscores the important role of the amygdala in generating the semiology, and raises several questions concerning the existence of "amygdalar epilepsy". The 11-year seizure-free period following the stereotactic destruction of the amygdala is a strong argument for this notion. The late seizure recurrence requiring a second operation might, however, be seen as an argument for the important role of the hippocampal formation in the syndrome of mesial temporal lobe epilepsy even when the amygdala has been identified as the seizure onset zone. The role of stereotactic amygdalotomy is briefly reviewed.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
2/16. Acute psychosis during intracranial EEG monitoring: close relationship between psychotic symptoms and discharges in amygdala.PURPOSE: This report examined the underlying mechanism of psychosis associated with epilepsy. methods: An adult patient with epilepsy manifesting acute psychosis during long-term EEG monitoring is presented, together with a literature review on this subject. RESULTS: A 25-year-old woman with intractable temporal lobe epilepsy developed acute psychosis while she underwent long-term intracranial EEG monitoring. After a clustering of seizures, she manifested psychotic symptoms including hallucination, stupor, and repeated fear. The transition of psychotic symptoms corresponded to the changes in frequency and morphology of seizure discharges restricted to the left amygdala. Improvement of psychosis coincided with disappearance of seizure discharges. CONCLUSIONS: This case confirmed a close relationship between psychotic symptoms and seizure discharges in the left amygdala. It is suggested that paroxysmal bombardment of the medial temporal lobe structure may be a pathogenetic factor of acute psychosis associated with epilepsy.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
3/16. Psychomotor-psychic seizures treated with bilateral amygdalotomy and orbitotomy.A 26-year-old woman developed seizures and psychiatric disorders after having been in coma with encephalitis for a protracted period at age 11. seizures were psychomotor, minor motor, and major motor with auras of fear, panic, and olfaction. The patient hallucinated, had paranoid ideas, was depressed, and attempted suicide. Medical and psychiatric treatment with anticonvulsants and tranquilizers was ineffective. Depth and surface EEG recordings revealed bilateral discharge abnormality in temporal, frontal, and thalamic areas. Lesions were placed in the temporal and orbitofrontal area bilaterally for the psycho-motor-psychic seizures and in the left thalamus for the minor motor seizure. The seizures were relieved without the incapacitating complications that occur with standard lobotomy and temporal lobe resection. Improvement of the psychic component of the seizures is believed due to interrupting seizure discharging circuitry in the temporal and frontal areas. The term temporofrontal seizures is proposed for the anatomic designation of psychomotor-psychic seizures.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
4/16. panic attack symptoms in a patient with left temporal lobe epilepsy.We describe a 56-year-old woman with left temporal lobe epilepsy who developed symptoms of a panic attack. Owing to normal electroencephalography and brain magnetic resonance imaging results, she was initially diagnosed as suffering from panic attacks and treated for anxiety neurosis. The symptoms persisted and she was re-examined in our department. An interictal electroencephalogram showed paroxysmal spike waves in the left mesial temporal lobe region and this was the basis for a diagnosis of left temporal lobe epilepsy. This report suggests that left temporal lobe epilepsy should be considered as the differential diagnosis when patients frequently complain of fear or anxiety.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
5/16. A case of "double" depression under outpatient treatment conditions.During his professional practice the author encountered a case of coexistence of "major depression" with psychic depressive attacks (dysthymic attacks) of so-called temporal epilepsy. Apart from major depression of medium intensity, other manifestations developed. These were independent of the time of the day, suddenly occurring within several seconds, developing without any cause, attacks of very strong dejection, sadness, breakdown, feeling of lacking sense and hopelessness of life with slight lessening of consciousness and strong groundless fear. Detailed psychiatric examinations, observations of the patient during such attacks and EEG records confirmed the diagnosis of dysthymic attacks of temporal epilepsy. The author treated the patient with sertraline starting at a low dose and increasing up to 100 mg daily - administered orally once daily in the morning, clonazepam in oral doses 1 mg in the morning, 1 mg at lunchtime, 2 mg in the evening, and carbamazepine 200 mg tablets from low doses to 400 mg administered once daily in the evening. Complete remission of major depression and complete regression of dysthymic attacks of "temporal epilepsy" were obtained.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
6/16. Emotion recognition from facial expressions in a temporal lobe epileptic patient with ictal fear.Ictal fear (IF) is an affective aura observed in patients with temporal lobe epilepsy. It has been suggested that the amygdala, a region implicated in emotion processing, is involved in generating IF. Several studies have reported that the patients with IF have disturbances in emotional experience, but there has been no testing of the emotional recognition in those patients. In this report, emotion recognition from facial expressions was investigated in a patient with IF. The patient suffered from IF due to temporal lobe epilepsy, and underwent hippocampectomy surgery which completely suppressed IF. We examined the patient before and after surgery. Before surgery, the patient tended to attach enhanced fear, sadness, and anger to various facial expressions. After surgery, such biases disappeared. As an underlying mechanism of the pre-surgical skewed perception of emotional stimuli, the abnormal epileptogenic circuits involving a hypersensitive amygdala possibly due to the kindling mechanism were suggested.- - - - - - - - - - ranking = 6keywords = fear (Clic here for more details about this article) |
7/16. Familial temporal lobe epilepsy as a presenting feature of choreoacanthocytosis.PURPOSE: Choreoacanthocytosis (ChAc) is an autosomal recessive disorder caused by mutations in VPS13A on chromosome 9q21 and characterized by neurodegeneration and red cell acanthocytosis. seizures are not uncommon in ChAc but have not been well characterized in the literature. We report two ChAc families in which patients presented with temporal lobe epilepsy. methods: Detailed medical and family histories were obtained. EEG, video-telemetry, brain magnetic resonance imaging (MRI) with volumetric studies of amygdala and hippocampus, as well as neuropsychological testing were performed. blood smears were examined for acanthocytosis. mutation analysis of VPS13A was carried out in five patients. RESULTS: Six patients in three sibships were initially seen with seizures. Age at seizure onset ranged from 22 to 38 years. seizures preceded other clinical manifestations of ChAc by < or = 15 years. The epileptic aura consisted of a sensation of deja-vu, fear, hallucinations, palpitations, or vertigo. EEG with video-telemetry showed epileptiform discharges originating either from one or both temporal lobes. epilepsy was generally well controlled, but some patients had periods of increased seizure frequency requiring treatment with multiple antiepileptic drugs (AEDs). Both families shared a deletion of exons 70-73 of VPS13A, extending to exons 6-7 of GNA14. CONCLUSIONS: temporal lobe epilepsy may be the presenting feature of ChAc and may delay its diagnosis. epilepsy in ChAc patients represents a challenge, because seizures may at times be difficult to control, and some AEDs may worsen the involuntary movements. Mutations in VPS13A or GNA14 or both may be associated with clinical features of temporal lobe epilepsy.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
8/16. Postictal psychosis after partial complex seizures: a multiple case study.Bouts of unusually frequent partial complex seizures originating in the temporal lobe, that sometimes became secondarily generalized, induced psychotic episodes in 9 patients. In 7, the increase in seizures occurred at a time when antiepileptic drugs (AEDs) were being reduced during intensive EEG monitoring with a view to surgical treatment of intractable epilepsy. According to DSM-III-R criteria, the postictal psychosis resembled an organic delusional syndrome which was paranoid in 7 and schizophreniform in 1 and an organic mood syndrome in 1. A high incidence of ictal fear, of bilateral independent epileptogenic discharge, and of small foreign tissue lesion were unexpected findings and appeared to represent risk factors, especially in patients otherwise handicapped by an epileptic personality disorder. Recognition of postictal psychosis in this setting and in others is important both prognostically and therapeutically. Postictal psychosis does not constitute a contraindication to surgical treatment of epilepsy.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
9/16. fear episodes due to limbic seizures with normal ictal scalp EEG: a subdural electrographic study.The authors present the case of a 13-year-old girl with episodes characterized by either staring with preserved consciousness or fear in whom functional illness was suspected. Video-EEG telemetry revealed no changes during 30 of 32 attacks. Subdural electrode recordings revealed epileptiform discharges in 30 of 37 episodes. The discharge was always localized to the electrodes recording from the inferomedial temporal region, with electrodes over the lateral convexity of the same temporal lobe showing no background changes. Although the detailed pathophysiology of panic attacks remains to be clarified, the authors point out that their case and other epileptic case studies are consistent with the possibility that excessive neuronal activity in medial temporal lobe structures is a necessary element of the underlying mechanism.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
10/16. The theme of death in complex partial seizures.The theme of death highlighted the depersonalization phenomena of four patients with complex partial seizures. These patients became preoccupied with death in association with psychomotor seizures, visual hallucinations, and altered perception of time and reality. The episodic sense of being dead or of having an appointment with death is a clue to the diagnosis of recurrent complex partial seizures even without overt motor stigmata of seizures. The syndrome differs from fear of death, steroid psychosis, the "near death syndrome," and Cotard's syndrome. Adjustment of antiseizure medication is an important therapeutic maneuver.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
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