22 Med. Sci. & L. 1 (1982)

handle is hein.journals/mdsclw22 and id is 1 raw text is: 

Med. Sci. Law (1982) Vol. 22, No. 1  Printed in Great Britain


Editorial


In  a  recent  report of  some  5500   epileptic
patients  who  had  been screened  to find any
history  of aggressive phenomena   during their
seizures, only  19 such  cases were found  and
eventually  this was  broken   down  to  13  of
which  just over  half (7) exhibited significant
aggression during their seizures. This aggression
varied  from  shouting  insults and spitting to
karate chops and smashing  property. This study,
therefore, neatly  confirmed  the clinical view
that  aggressive phenomena, including quite
destructive  acts, can  arise  during  epileptic
seizures, but that such aggression is rare. It was
unclear   whether    patients  were   routinely
provoked   by  touching or  mauling  during the
post-ictal phase, and whether aggression begin-
ning later after the seizure, was included.
   The  research was stimulated originally by an
increasing  number   of reported  cases in  the
United  States in which 'epilepsy' had been used
as a defence  in homicide  cases, but as is well
known   there are very few published reports of
homicidal  behaviour  during phases  of altered
consciousness of epileptic seizures.
   As  far as the United Kingdom  is concerned
only  three such  cases have been  reported. In
spite of this report there is still a readiness on
the  part  of American   medico-legal cases  to
attribute impulsive  violence in an  individual
with a minor, or non-specific electroencephalo-
graphic  abnormality   to  epilepsy, with  the
speculation  that  the  only  manifestation  of
epilepsy  in  the individual  concerned  is an
occasional outburst of  impulsive violence. The
only  tenable argument  in our present state of
knowledge   is to insist that epilepsy must be
diagnosed  only when  there is definite evidence
of altered consciousness or stereotyped motor
or sensory phenomena coinciding with labora-
tory  evidence of electric dysrhythmia  in the
brain. If a criminal assault is to be attributed to


epilepsy, then  the  assault itself should meet
established criteria for epilepsy. It must arise in
an individual in whom epilepsy can be diagnosed
confidently  from  phenomena   other than  that
particular incident in question.
   There  is some   difficulty in understanding
what  motivated  the enthusiasm  for associating
violence  and  epilepsy, but  presumably   this
complex   answer   depends  on  the  legal con-
sequences  of successfully pleading epilepsy as a
determinant   of   violence and   therapeutics,
particularly in the United  States where some
States still retain capital punishment and where
a successful plea of illness or automatism will
prevent  the death sentence being pronounced.
Fortunately  such pressure is no longer the case
in Britain. In England  and Wales  a successful
defence  of epileptic automatism  to a  violent
crime  leads  to hospital confinement   at the
pleasure of the Home   Secretary. No statistical
relation between   violence and   epilepsy was
found   when   this  implied  relationship was
investigated, but it was suggested there may be
indirect ways  in  which  the two  phenomena
may   be  linked in  individual cases. Namely,
that  some  epileptics are brain-damaged   and
disinhibited, while others are resentful about
their social condition and consequences  and a
few  of the latter cope  with their resentment
aggressively. Lack of parental care in the early
stages may in addition lead to head injuries, ear
infections and  similar conditions  which  are
associated  in themselves   with an  increased
prevalence  of convulsive  disorders. Similarly,
violent and  reckless behaviour  brings an  in-
creased risk of  head  injury and  seizures. It
would  be of great interest, therefore, to receive
the views of the legal and psychiatric members
of the Academy   concerning the results of such
research.


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