In the same way as other negative aspects of epilepsy may have been played down by the mainstream epilepsy movement, there has been outright denial of the ‘epileptic personality’. While this is a hopelessly over-simplified concept, many doctors believe that certain people with epilepsy do have mood disorders which are not concerned with emotional reactions such as grief on diagnosis, but moods which exist by themselves, and which relate to electrical changes in the brain. For example, Norman Geschwind, who gave his name to the Geschwind Syndrome, studied those with ‘temporal lobe seizure disorder’, and found characteristic personality traits including preoccupation with philosophical or religious issues; long-windedness; altered (almost always lowered) sexuality; and irritability. Needless to say, his findings were hotly disputed by his medical colleagues, though Geschwind believed firmly in the syndrome. Another neuropsychiatrist who has done a great deal of work in this area is Dietrich Blumer, who has focused on changing moods and psychoses as part of this phenomenon. According to Blumer, mood changes are the most important mental disorders related to epilepsy and cannot be seen merely as reactions to having a difficult life situation.
So, is there any truth in all this, or is it just neurological fancy of the highest order?
According to Living well with epilepsy and other seizure disorders By Carl W. Bazil, cognitive, behavioural and emotional symptoms can occur as a result of different brain disorders. In people with epilepsy, changes in thinking, personality and mood can be because of several factors.
First, the psychological aspect of epilepsy definitely has to be taken into account when considering people’s experience of epilepsy. One common factor in ‘moodiness9 is the stress associated with adjusting to a chronic medical problem and all its implications.
Mood changes may also be due to underlying brain abnormality which causes changes in electrical brain activity including seizures. This may happen as the prodrome, or build up to a seizure, and the person with epilepsy may not necessarily be aware of his or her ‘moodiness’.
More light may be thrown on this as medical investigative techniques advance. At some research centres, studies using advanced brain-imaging techniques are examining relationships between different behavioural symptoms and brain dysfunction in epilepsy patients. Indeed, epilepsy may well turn out to be the disorder of the twenty-first century, as these investigative techniques become delicate and precise enough to highlight the subtle structure and workings of the brain.
Seizure activity itself can sometimes affect feelings and outlook at depth, especially in temporal lobe epilepsy involving an aura, for example. The limbic system is closely associated with emotional life, and, when it is disturbed as in an aura, the person is likely to experience various strong emotional experiences such as fear, deja vu, depersonalization (i.e., feeling ‘not there’ or detached from the scene). Over time, and especially if they began in childhood, these passing but powerful and repeated abnormal experiences, which at the time seem too real to be hallucinations, become integrated into the psychic life of the person.
Temporal lobe epilepsy itself has attracted a certain amount of attention as representing the ‘sexier’ end of epilepsy, and it has been linked with creativity and visionary experiences. Every artist with a claim to TLE has been drawn in, Van Gogh being one of the most typical examples! Certainly, those who experience striking hallucinations as part of an aura may resent having them dumbed down by medication.
Seizure control is usually viewed as the criterion for success in epilepsy treatment, but some disagree!
Interestingly on this point, there are a few people, usually with lesions in the temporal lobe, who suffer psychotic illness with symptoms similar to those of paranoid schizophrenia according to Living well with epilepsy and other seizure disorders By Carl W. Bazil. In this small group, the psychosis lessens when a person has more seizures, but becomes worse as the seizures are got under control – a phenomenon known as ‘forced normalization’. A change in drugs can sometimes change personality ‘problems’.
However, it is much more common that difficult personality traits improve when seizure frequency is reduced by the right medication. Anti-epileptic drugs are another factor which can cause changes in mood and behaviour, especially if the dose is too high, when intoxication may result, or too low, when ‘breakthrough’ seizures may happen.