Sb Lek. 1996;97(1):71-95.

"Epileptosis"--a syndrome or useless speculation?

Faber J1, Vladyka V, Dufková D, Faltus F, Jirák R, Pavlovský P, Smídová E, Zvolský P, Zukov I, Klár I, Posmurová M, Srutová L.   1Neurological Department, 1st Faculty of Medicine, Charles University; Prague, Czech Republic.

102 patients were divided into 3 groups: epileptics, psychotics and epileptics with psychotic symptoms.

All had long been monitored for a number of clinical and laboratory parameters. Though different in many respects, all share states of sudden dysphoria, cacophoria, panic anxiety, horror, and EEG (stereo-EEG, too) signs of epileptic or other gross anomalies, often correlated to those affective disorders. Attacks of dysphoria, epilepsy, and psychosis come spontaneously and in response to:

• biological  - hypoglycemia, sleep deprivation, alcohol, menses or
• psychosocial stimulation - agitation, quarrels, fear of redundancy, psychic trauma

These states (attacks, dysphoria, "neurotic" or even psychotic episodes) often provoke one another.

-Calling this syndrome epileptosis, we believe its mechanism is due to lesions of the limbic and brainstem modulation systems. At the start of the process there is an epileptic focus in the amygdalo-hippocampal complex (AHC) which in itself can trigger simple or complex partial paroxysm but also-by means of electric stimulation of the AHC-states of dysphoria, anxiety, and psychotic hallucinations.

Besides, a form of pathological learning develops in premorbid "hypersensitive" personality which can be put down to associative learning and to Overton's phenomenon of "state-dependent retention of learned responses". This may give rise to mutual stimulation where epileptic focal activity in AHC can provoke dysphoria while an external psychosocial situation can trigger epileptic activity there, too (AHC). Since there need not always be mydriasis (though other vegetative signs such as tachycardia, tachypnoea, nausea, blush and others are frequent) or unconsciousness, and some psychomotor manifestations may be out of the ordinary, and scalp EEG may be normal, such patients are often regarded as "hysterics" or malingerers.

PMID:  8711419