Josh Spiers's Public Library

Symptoms






In about 20% of people who have a seizure disorder, seizures are preceded by unusual sensations (called aura), such as the following:

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  Abnormal smells or tastes
  
  
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  Butterflies in the stomach
  
  
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  A feeling of déjà vu
  
  
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  An intense feeling that a seizure is about to begin

• Visual hallucinations (seeing unformed images) if the occipital lobe is affected
  
  
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  Inability to speak if the area that controls speech (located in the frontal lobe) is affected

In complex
partial seizures, abnormal electrical discharges begin in a small area of the temporal lobe or frontal lobe and quickly spread to other nearby areas. The seizures usually begin with an aura that lasts 1 to 2 minutes. During the aura, people start to lose touch with the surroundings. During the seizure, consciousness is impaired but not completely lost. People may do the following:

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  Stare
  
  
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  Chew or smack the lips involuntarily
  
  
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  Move the hands, arms, and legs in strange, purposeless ways
  
  
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  Utter meaningless sounds
  
  
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  Not understand what other people are saying
  
  
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  Resist help

Carbamazepine Some Trade Names

TEGRETOL

Generalized seizures

Partial seizures

A low white blood cell count (granulocytopenia), production of too few blood cells (aplastic anemia, which can be fatal disorder), a low platelet count (thrombocytopenia), digestive upset, inability to articulate words, lethargy, dizziness, and visual disturbances

Clonazepam Some Trade Names

KLONOPIN

Atonic seizuresAtypical absence seizures

Infantile spasms

Myoclonic seizures

Drowsiness, abnormal behavior, loss of coordination, and lost effectiveness of the drug after 1 to 6 months

Altogether Penfield (Mullan and Penfield 1959) divided the illusions of interpretation into four groups:

Auditory illusions accompanied by the perception that sounds were louder or clearer, fainter or more distinct, nearer or farther away;

Visual illusions where things seemed clearer or blurred, nearer or farther away, larger or smaller; fatter or thinner;

Illusions of recognition where present experience seemed familiar, strange, altered or unreal; and

Illusions of emotion consisting of feelings of fear, loneliness, sorrow or disgust.

Total management of TLE by a psychiatrist is also not without problems. Although temporal lobe epileptic patients are particularly intriguing to psychiatrists because of the nature of the symptoms, these "psychic" seizures can generalize at any time into psychomotor status or grand mal attacks. What's more, neither the timing nor the seriousness of grand mal episodes can be predicted; the initial generalized seizure sometimes occurs many years after the first manifestations of the illness and may culminate in status epilepticus and death.

For these reasons, a physician should undertake the treatment of TLE patients only if he or she has sufficient training and experience in the overall management of epilepsy. When this isn't the case, close collaboration between psychiatrist and neurologist offers the best venue for successful management of this fascinating "bridge" between neurology and psychiatry.