Occurrence of “Continuous Symptoms” in Epilepsy Patients

Abstract

Patients with convulsive disorders sometimes complain of prolonged non-ictal symptoms in the course of medical anti-convulsant therapy. Frequently these reactions appear to be related to the cerebral mechanism producing seizures. The presence of one or more of the following findings suggest this: (1) the appearance of symptoms resembling the characteristic aura; (2) the appearance of symptoms related to the known function of a cortical area in which a focal electrographic disturbance can be demonstrated; (3) the disappearance, or marked modification, of symptoms following the occurrence of a seizure. However, some cases occur in which it is impossible to rule out the possibility that symptoms may be due to a specific drug intolerance or unassociated somatic or psychoneurotic conditions. In 100 consecutive cases of convulsive disorders treated medically, 12 developed symptoms suggesting this type of reaction. These were most prominent in patients with clinical or electrographic evidence of a temporal lobe disturbance which was not progressive during the course of observation and fell into three main groups: (1) visceral symptoms which frequently suggested a psychoneurotic reaction; (2) psychiatric symptoms, which included both affective and intellectual disturbances; (3) somatic sensations, which appear to be both rare and, since they create little emotional disturbance, less frequently reported. These reactions are not drug specific, but are not prominent in patients controlled predominantly with phenobarbital and in many cases appear to represent a transient phase during the course of therapy. It is suggested that the concept of a continuous "intellectual" or affective aura, may offer some clue to the problem of the epileptic patient who becomes psychotic during drug therapy.