Overt aggressive behaviors occur in a minority of people with epilepsy. Certain typical features are common to most episodes of aggression in patients with TLE. These features may differ depending on when they occur:

Ictal phase

• rare, usually unintended and nondirected, related to stereotyped movements
• other signs or symptoms of seizures may be present, including EEG abnormalities

Postictal phase

• usually part of postictal confusion, irritability, depression, or pain
• tends to be brief, nondirected
• may intensify if the patient is approached or restrained Interictal phase
• tends to occur as a component of other interictal behavioral changes
• follows rather than precedes the onset of epilepsy
• patient tends to take responsibility for his or her actions, may express remorse about consequences and espouse moral or religious convictions

The last feature above is helpful in distinguishing patients with interictal aggression from those with antisocial personality disorders. Aggressive behavior among people with epilepsy may be more common in those whose early life included disruption or physical abuse, or those with histories of fire setting, animal torture, conduct disorder, or substance abuse.

Adapted from: Holzer JC and Bear DM. Psychiatric considerations in patients with epilepsy. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 131-148.
With permission from Elsevier (www.elsevier.com)
Reviewed and extensively revised April 2004 by Andres M. Kanner, M.D., epilepsy.com Editorial Board