Violence and epilepsy

Violence and epilepsy | November 13, 2024

No question about it. Epilepsy’s been the victim of bad press since ancient Greece.

There, it was sometimes called the “Herculean Disease” because Hercules was thought to have murdered his family in a fit of uncontrollable rage.

Two thousand years later, Michael Crichton wrote in The Terminal Man, “Epileptics are predisposed to violent, aggressive behavior during their attacks.”

Which didn’t exactly help.

In later editions of his novel, Crichton softened his stance with a postscript, but many physicians and laymen still truly believe that those with epilepsy are dangerous and potentially violent people.

British psychiatrist Henry Maudsley suggested that “whenever a murder occurs, without premeditation…we ought to look carefully for evidence of previous epilepsy.”

In the film “Deceiver,” a psychiatrist describes a person with epilepsy as “one of the most dangerous creatures on earth,” and recommends that police officers treat him as you would treat a strange dog in an alley, “don’t talk to him, don’t look him in the eye, and whatever you do, don’t touch him.”

Lovely. But they’re not the first to have these biased attitudes. (And they’re considered to be educated, “smart” men!)

Two schools of thought…

There’s a long-standing belief that temporal lobe epilepsy (TLE) is the epilepsy syndrome most often complicated by interictal (the time between seizures) cognitive and behavioral problems.

Criminologist Cesare Lombroso promoted the association of epilepsy with aggressive, sociopathic tendencies.

But modern research rejects the idea that having epilepsy makes you automatically prone to violence. However, studies do show increased violence among those with seizures as compared with those without seizures.

An international workshop found that aggressive acts “appeared suddenly, without evidence of planning, lasted an average of 29 seconds and occurred during partial complex seizures.”

They pointed out that the most important aspect to these acts is they were random and that the aggressive action was extremely brief.

Members of the workshop also determined that fear or an attempt at restraining the subject exacerbated these aggressive acts. (Hey, who would want to be pinned down, tied up or put in cuffs?)

They determined, that it would be “a near impossibility” for a person having a seizure to commit a directed act of violence.

While it’s true that compared with the general population, violent behavior occurs more often among those with epilepsy, seizures are most aggressive at the interictal stage, between seizures and can correlate with: frontal lobe deficits, neurotransmitter abnormalities, perinatal neurological damage and behavioral genetics.

Other biological aspects influencing aggressive behavior in epilepsy can be: male gender, psychopathology, low intelligence or cognitive deficits.

Also included are prior head trauma, or abnormal neurological studies, even medication side effects, and possibly the experience of child abuse.

Unfortunately, the interictal period comprises more than 99% of most patients’ lives, making this a continuing problem even though the seizures themselves are intermittent.

Clinicians need to be aware of the different relationships between epilepsy and violence, especially when choosing management with anticonvulsant medications, psychoactive drugs, or in some cases, surgery.

Because, the effectiveness of one may defeat the other.

So, it’s a real double bind.

And then there’s the debate of pre-existing psychosis versus psychosis being a by-product of seizures.

I don’t think anyone is going to win that debate, because each situation is entirely possible.

While “automatic” aggression is higher in those with epilepsy, the incidence and prevalence of psychosis and aggression in epilepsy, are still unknown.

The question is: what’s triggering what?

Besides, that kind of aggression isn’t really any different from the violent behavior of other patients who experience psychotic episodes because of other illnesses.

It’s not simply a matter of “A” (partial complex seizures) + “B” (the interictal stage) = “C” (aggressive acts and violence.)

You can have epilepsy and not be psychotic. And you can be psychotic and not have epilepsy. What’s so difficult about that?

But old biases die hard. And we still have a long way to go to prove to people who those with epilepsy aren’t crazy, aggressive or violent.

Only through education and awareness can we change those odious opinions.

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Resources:

http://jamanetwork.com/journals/jama/article-abstract/336801

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3053027/

http://www.epilepsy.com/learn/impact/moods-and-behavior/mood-and-behavior-101/aggression

http://www.sciencedirect.com/science/article/pii/S2213323213000224

http://io9.gizmodo.com/was-michael-crichton-right-about-a-link-between-epileps-509012575

https://pubmed.ncbi.nlm.nih.gov/3720715/