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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. 1

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