ICTAL DEPRESSION AND ANXIETY IN TEMPORAL LOBE DISORDERS

Whereas affective disturbances may accompany almost any organic cerebral disorder, the occurrence of "ictal emotions" (suddenly occurring and again disappearing emotional reactions) are frequently associated with disorders of the temporal lobe.

We noted a distinct relationship between paroxysmal, depressive reactions and uncinate attacks. Ictal depressions lasting from hours to weeks occurred in 7 subjects whose principal seizure manifestations consisted of uncinate attacks and temporal lobe automatisms. Depressive episodes preceded or followed temporal lobe seizures or occurred paroxysmally in the "free interval" between seizures. Serial EEG's demonstrate that this particular type of depressive reaction may be due to subclinica 'hippocampal-amygdaloid-temporal lobe epilepsy" and/or due to afterdischarges from the same structures following manifest seizure activation.

The occurrence of paroxysmal fear, or "isolated anxiety" has been sporadically mentioned in the literature as a correlate of temporal lobe seizures, particularly as expression of a temporal lobe aura. We noted "paroxysmal anxiety" in 4 subjects, not only immediately preceding temporal lobe seizures, but also as an "isolated," affective phenomenon in the so-called "free interval." These anxiety attacks seem to bear a relationship to "firing" of the temporal lobe cortex, as demonstrated by our serial EEG observations and as evidenced by Penfield and co-workers during electrical stimulation. [SEE FIG. 7. IN SOURCE PDF.]