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11 - Paradoxical phenomena in epilepsy

Published online by Cambridge University Press:  05 December 2011

By
Steven C. Schachter
Edited by
Narinder Kapur
With
Alvaro Pascual-Leone ,
Vilayanur Ramachandran ,
Jonathan Cole ,
Sergio Della Sala ,
Tom Manly  and
Andrew Mayes
Foreword by
Oliver Sacks
Steven C. Schachter
Affiliation:
Harvard Medical School
Narinder Kapur
Affiliation:
University College London
Alvaro Pascual-Leone
Affiliation:
Harvard Medical School
Vilayanur Ramachandran
Affiliation:
University of California, San Diego
Jonathan Cole
Affiliation:
University of Bournemouth
Sergio Della Sala
Affiliation:
University of Edinburgh
Tom Manly
Affiliation:
MRC Cognition and Brain Sciences Unit
Andrew Mayes
Affiliation:
University of Manchester
Oliver Sacks
Affiliation:
Columbia University Medical Center
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Summary

Summary

The impact of epilepsy on patients is determined by the frequency and severity of seizures, seizure-related symptoms, medication side-effects, the underlying cause and associated psychosocial issues. Paradoxical phenomena have been described in each of these domains, including unexpected worsening or improvement in seizure frequency, causes of epilepsy that can also precipitate a remission, extraordinary seizure-related experiences and psychiatric consequences. This chapter provides a brief overview of these and related topics. A fuller understanding of these paradoxical phenomena should yield unique insights into the development and pathophysiology of epilepsy, as well as illuminate the borderlands between mind and brain, and between neurology and psychiatry.

Introduction

Epilepsy is a common neurological disorder that affects persons of all ages and socioeconomic backgrounds. An estimated 2 to 4 million people in the United States have epilepsy (Hauser and Hesdorffer,1990), with approximately 200,000 newly diagnosed cases each year. Worldwide, approximately 50 million persons have epilepsy, the large majority of whom do not receive therapy, largely because of limited access to medical care and due to the costs of treatment.

The many causes of epilepsy include congenital brain malformations, metabolic diseases, brain trauma, brain tumours and abscesses, stroke, vascular malformations and cerebral degeneration. The most common causes vary as a function of age, degree of treatment resistance and whether the anatomic origin of seizure onset is focal, regional or diffuse. The most common pathology seen in the resected brain tissue of patients who undergo temporal lobectomies for focal-onset treatment-resistant epilepsy is hippocampal sclerosis.

Type
Chapter
Information
The Paradoxical Brain , pp. 204 - 220
Publisher: Cambridge University Press
Print publication year: 2011

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