Clinical and Electroencephalographic Studies of Temporal Lobe Function

Abstract

The relationship of temporal lobe dysfunction and mental disturbance has been investigated in 82 cases with localized temporal abnormality, chosen from 3000 EEG reports from the Maudsley Hospital. In the majority of cases the abnormal activity was localized to the posterior and inferior positions. Of the 82 cases, 23 were considered to be due to an acquired lesion. 59 cases were considered to be of constitutional origin. An attempt was made to classify the non-acquired cases from both the EEG and the clinical points of view independently of each other. The EEG were classified into 3 types: (1) the epileptic records, with undoubted epileptic foci[long dash]spike foci or slow wave foci, (2) the epileptoid records, with paroxysmal sharp waves, paroxysmal fast and slow activity, or runs of fast beta activity, (3) the constitutional records, with slow wave dysrhythmia only. Clinically, the cases were divided into 2 groups: one with known acquired lesions, and the other consisting of cases suffering from a "functional" type of illness. Patients from the "functional" group had certain psychopathological features in common. However, they also differed in certain aspects and these cases could be separated into 2 groups: those with and those without typical epileptic manifestations. The group without obvious epileptic manifestations could be divided into 2 sub-groups, the one being distinguished from the other by what might be called disorders of consciousness and behavior of an episodic nature. When these "functional" clinical groups were compared with the EEG findings, they were found to correspond roughly to the 3 EEG types, respectively. The following clinical features were found to be common to the non-acquired cases: (a) Personality: inability to adapt themselves to their environment, inability to make friends or to keep them, inability to mix with others in a normal way, inability to remain at same occupation, inability to assume responsibility or to be successful. Of the 59 cases, 40 showed the characteristic personality picture. (b) Aggression of a pathological degree and of an overt type was present in 29 cases and irritability was present in another 15. (c) Anxiety shown by these patients appeared to be different from the anxiety of ordinary psychoneurotics. It seemed to be a sensation at a much lower level of experience. The general hypothesis was advanced that there is in these patients a defect or lack of maturation in the temporal lobes, more particularly of the posterior temporal areas, seen physiologically in the EEG abnormalities, and psychologically in the clinical picture.