Epilepsy Spectrum Disorder

Seizure, cont.

Like patients with classic complex partial seizure (CPSz) disorders (Devinsky & Luciano 1991), ESD patients report experiencing a variety of sensory, cognitive, and affective symptoms including olfactory hallucinations, memory gaps, confusional spells, jamais vu, episodic dysphasia and ictal fear. A listing of the partial seizure-like symptoms most frequently endorsed by ESD patients is presented in Table 1 (adapted from Roberts et al. 1990). Unlike patients with classic CPSz disorders, ESD patients do not experience their symptoms in a predictable stereotypic sequence. The patients with ESD are likely to experience each symptom in a seemingly random or piecemeal fashion, one or two at a time. In the majority of cases, the standard EEGs obtained from ESD patients are typically interpreted as being within normal limits or as showing abnormalities not clearly epileptiform in nature (Roberts et al. 1992, Varney et al. 1992). Nevertheless, a clear majority respond well to anti-convulsant medications, particularly carbamazepine and valproic acid, even when there has been a history of profound treatment failure with more traditional psychotropic medications such as tricylic antidepressants, antipsychotics, and lithium (Barnhill & Gualtieri 1990, Hayes & Goldsmith 1991, Neppe & Kaplan 1988, Neppe et al. 1991, Roberts et al. 1990, Springer et al. 1991, Tucker et al. 1986, Varney et al. 1993, Verduyn et al. 1992). Thus, although the phenomenology of ESD and the positive clinical response to anti-convulsant seen in most ESD patients would suggest the presence of subclinical electrophysiological dysfunction, the lack of clear non-behavioral evidence of CNS dysfunction (i.e., EEG) may obscure the underlying neurological nature of ESD (Roberts et al. 1992).

Nature of ESD

Seizure

How best to conceptualize the neurobehavioral disorder characterized by multiple episodic symptoms has been a matter for considerable debate (Roberts 1989, Springer et al. 1991). In their seminal paper, Tucker et al. (1986) used both the phrase "complex partial seizures" and the diagnosis "atypical psychosis" to characterize their patients. Episodic dyscontrol (Elliot 1982, Monroe 1970), subictal neurosis (Jonas 1982) and limbic ictus (Monroe 1982) have also been used to describe these patients. It has been argued by Springer and others that use of the word "psychosis" obscures the fact that the interictal behavior of these patients is relatively normal. Patients with a partial seizure-like disorder also differ from psychotic patients in the nature of their hallucinatory episodes which are more like sensory illusions, and the manner in which they can describe those experiences (Springer et al. 1991, Roberts et al. 1992). Similarly, describing patients with multiple partial seizure-like symptoms as manifesting a variant of a complex partial seizure disorder is potentially misleading and likely to generate controversy (Tucker et al. 1986, Roberts et al. 1990). Although some epileptologists would regard the clinical presentations of the patients described here as consistent with the presence of complex partial seizures, neurologists would not. Finally, the diagnosis of simple partial seizures is inappropriate because the number of symptoms reported is too great. As has been argued previously, a more conservative approach is to regard these patients as manifesting an "epilepsy spectrum disorder" analogous to the concept of "schizophrenia spectrum disorder." (Springer et al. 1991, Roberts et al. 1992)

Next: Clinical Presentation of ESD Patients

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For a full treatment of the topic of brain injury, and recovering adequate compensation for those who have survived such injury, please visit our other pages. tbilaw.com A general treatment of all types of brain injury, including severe brain injury and concussion, with a special focus on the legal aspects of recovering full and adequate compensation for such injuries. tbilaw.com has been at the cornerstone of the web advocacy of the Brain Injury Law Group since it went online in 1996. waiting.com A page designed to assist those with issues regarding coma, especially in the acute phase when the doctors are saying "I just don't know." vestibulardisorder.com Addressing vertigo and dizziness resulting from trauma as well as information and resources for vestibular disorders.

Sensory Brain

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