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Acute postictal confusion and violence: Two cases with unfortunate outcomes.

ABSTRACT: Patients with temporal lobe epilepsy (TLE) often have a brief postictal state characterized by confusion and disorientation. Less common postictal behaviors include wandering and violence - both reactive and spontaneous. We describe two male patients with left TLE and unusual postictal states that led to unfortunate outcomes. The first patient's postictal state included an intense urge to peregrinate, as well as reactive violence. When a frightened houseguest prevented the patient from exiting his bedroom during a postictal state, the patient climbed out the window and fell to his death. The second patient's postictal state included menacing posturing, loud exclamation of guttural sounds or profanities, clapping or smacking his hands together, and punching nearby objects. During a postictal state at home, he grabbed a bat and destroyed furnishings. After he had two seizures at work followed by his typical postictal state, he was dismissed because of his perceived threat to coworkers.

SUBMITTER: Grant AC

PROVIDER: S-EPMC4150615 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Acute postictal confusion and violence: Two cases with unfortunate outcomes.

Grant Arthur C AC Koziorynska Ewa E Lushbough Catherine C Maus Douglas D Mortati Katherine K

Epilepsy & behavior case reports 20130524

Patients with temporal lobe epilepsy (TLE) often have a brief postictal state characterized by confusion and disorientation. Less common postictal behaviors include wandering and violence - both reactive and spontaneous. We describe two male patients with left TLE and unusual postictal states that led to unfortunate outcomes. The first patient's postictal state included an intense urge to peregrinate, as well as reactive violence. When a frightened houseguest prevented the patient from exiting h ...[more]

PMID: 25667832

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Project description:Cultural biases and integration in novel socio-geographic contexts are relevant factors for the understanding of dynamics beneath sexual violence, and possibly play a role in modifying responsibility and perpetrators treatment. Here we offer a conceptual analysis of the relevant literature and two case study. Cultural factors influence power dynamics and individual values, impacting the occurrence of sexual violence; the understanding of "coercion" varies across cultures, and cultural legitimization may ensue. The consequences of sexual assault also differ, with shame prevailing in socio-centric societies and guilt in ego-centric societies. Rape and gender-based violence is influenced by masculinity and femininity concepts, the former identified with power. Dominance, rather than sexual gratification, can lead to sexual violence, which could also be a "male backlash" against gender equality. Biological theories link sexual violence to genetic factors; a psychodynamic perspective suggests an unconscious social reproduction of masculine culture and delves into possible explanations for violent behavior. Acculturation strategies and acculturative stress are explored, with a focus on Berry's strategies and on Camilleri's model of identity in intercultural situations. The impact of cultural factors on responsibility is discussed, highlighting variability in criminal laws and attitudes towards cultural offenses in different countries. The analysis of two criminal cases accused of rape, revealed common and diverging elements. Both individuals come from favorable socio-economic backgrounds, and lacked of prior or present psychiatric diagnoses. Integration difficulties, psychosexual attitudes, and the improper application of cultural codes played a crucial role. In conclusion, anthropological and ethnopsychiatric knowledge should be integrate into forensic assessments. Early detection of non-acculturation elements is need to prevent criminal behaviors, and a diagnostic instrument as a validated rating scale should be implemented.

Dataset Information

Acute postictal confusion and violence: Two cases with unfortunate outcomes.

Publications

Acute postictal confusion and violence: Two cases with unfortunate outcomes.

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