Geschwind syndrome

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Geschwind Syndrome, also known as Gastaut-Geschwind, is a group of behavioral phenomena evident in some temporal lobe epilepsy patients. It is named for one of the first individuals to categorize the symptoms, Norman Geschwind, who published prolifically on the topic from 1973 to 1984.[1] There is controversy surrounding whether it is a true neuropsychiatric disorder.[2] Temporal lobe epilepsy causes chronic, mild, interictal (i.e. between seizures) changes in personality, which slowly intensify over time.[1] Geschwind syndrome includes five primary changes; hypergraphia, hyperreligiosity, atypical (usually reduced) sexuality, circumstantiality, and intensified mental life.[3] Not all symptoms must be present for a diagnosis.[2]

Only a subset of patients with epilepsy in general and temporal lobe epilepsy in particular present with features of Geschwind syndrome[4] and a recent review concluded that the evidence for a link between temporal lobe epilepsy and hyperreligiosity "isn't terribly compelling."[5]

Features[edit]

Hypergraphia[edit]

Hypergraphia is the tendency for extensive and compulsive writing, and has been observed in Temporal Lobe Epilepsy patients who have had multiple seizures.[6] Those with hypergraphia have extreme attention to detail in their writing. Some patients keep diaries and write down meticulous details about their everyday lives. In certain cases, the writing of patients has demonstrated extreme interest in religious topics. Also, these individuals tend to have poor penmanship. The novelist Fyodor Dostoyevsky showed symptoms of Geschwind syndrome, including hypergraphia.[7]

Hyperreligiosity[edit]

Some individuals may exhibit increased, usually intense, religious feelings and philosophical interests,[8] and partial (temporal lobe) epilepsy patients with frequent numinous-like auras have greater ictal and interictal spirituality.[9] Some seizures include ecstatic experiences.[10] It has been reported that many religious leaders exhibit this form of epilepsy.[11][12] These religious feelings can motivate beliefs within any religion, including Voodoo,[13] Christianity, Islam,[14] and others. There are reports of patients converting between religions.[15] A few patients internalize their religious feelings: when asked if they are religious they say they are not.[16]

Atypical Sexuality[edit]

Geschwind patients reported higher rates of atypical or altered sexuality.[17] In approximately half of individuals hyposexuality (i.e. decreased libido) is reported.[18][19] Cases of hypersexuality have also been reported.[20]

Circumstantiality[edit]

Individuals that demonstrate circumstantiality (or Viscosity) tend to continue conversations for a long time and talk receptively.[21]

See also[edit]

References[edit]

  1. ^ a b Devinsky, J.; Schachter, S. (2009). "Norman Geschwind's contribution to the understanding of behavioral changes in temporal lobe epilepsy: The February 1974 lecture". Epilepsy & Behavior 15 (4): 417–24. doi:10.1016/j.yebeh.2009.06.006. PMID 19640791. 
  2. ^ a b Benson, D. F. (1991). "The Geschwind syndrome". Advances in neurology 55: 411–21. PMID 2003418. 
  3. ^ Tebartz Van Elst, L.; Krishnamoorthy, E. S.; Bäumer, D.; Selai, C.; von Gunten, A.; Gene-Cos, N.; Ebert, D.; Trimble, M. R. (2003). "Psychopathological profile in patients with severe bilateral hippocampal atrophy and temporal lobe epilepsy: Evidence in support of the Geschwind syndrome?". Epilepsy & Behavior 4 (3): 291. doi:10.1016/S1525-5050(03)00084-2. 
  4. ^ Benson, D.F. & Hermann, B.P. (1998) Personality disorders. In J. Engel Jr. & T.A. Pedley (Eds.) Epilepsy: A comprehensive textbook. Vol. II (pp.2065–2070). Philadelphia: Lippincott–Raven.
  5. ^ Craig Aaen-Stockdale (2012). "Neuroscience for the Soul". The Psychologist 25 (7): 520–523. 
  6. ^ Tremont, Geoffrey; Smith, Megan M; Bauer, Lyndsey; Alosco, Michael L; Davis, Jennifer D; Blum, Andrew S; LaFrance, W Curt (2012). "Comparison of personality characteristics on the bear-fedio inventory between patients with epilepsy and those with non-epileptic seizures.". The Journal of neuropsychiatry and clinical neurosciences 24 (1): 47–52. doi:10.1176/appi.neuropsych.11020039. 
  7. ^ Hughes, John R (2005). "The idiosyncratic aspects of the epilepsy of Fyodor Dostoevsky.". Epilepsy and behavior 7 (3): 531–8. 
  8. ^ Devinsky, Julie; Schachter, Steven (2009). "Norman Geschwind's contribution to the understanding of behavioral changes in temporal lobe epilepsy: the February 1974 lecture.". Epilepsy & behavior 15 (4): 417–24. PMID 19640791. 
  9. ^ Dolgoff-Kaspar, R (et al.) (2011). "Numinous-like auras and spirituality in persons with partial seizures.". Epilepsia 52 (3): 640–6. doi:10.1111/j.1528-1167.2010.02957.x. PMID 21395568. Epilepsy patients with frequent numinous-like auras have greater ictal and interictal spirituality of an experiential, personalized, and atypical form, which may be distinct from traditional, culturally based religiosity. 
  10. ^ Picard, Fabienne; Kurth, Florian (2014). "Ictal alterations of consciousness during ecstatic seizures.". Epilepsy & Behavior 30: 58—61. PMID 24436968. Lay summary. Patients with ecstatic epileptic seizures report an altered consciousness, which they describe as a sense of heightened perception of themselves - they "feel very present"- and an increased vividness of sensory perceptions. 
  11. ^ Muhammed, Louwai (2013). "A retrospective diagnosis of epilepsy in three historical figures: St Paul, Joan of Arc and Socrates.". Journal of medical biography 21 (4): 208–11. doi:10.1177/0967772013479757. 
  12. ^ Nakken, Karl O; Brodtkorb, Eylert (2011). "[Epilepsy and religion].". Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række 131 (13-14): 1294–7. doi:10.4045/tidsskr.10.1049. 
  13. ^ Carrazana E. (et al.) (1999). "Epilepsy and Religious Experiences: Voodoo Possession". Epilepsia 40 (2): 239–241. doi:10.1111/j.1528-1157.1999.tb02081.x. Lay summaryEpileptic seizures have a historical association with religion, primarily through the concept of spirit possession. Five cases where epileptic seizures were initially attributed to Voodoo spirit possession are presented. The attribution is discussed within the context of the Voodoo belief system. 
  14. ^ Stephen, M.D. Salloway (1997). "The Neural Substrates of Religious Experience". The Neuropsychiatry of Limbic and Subcortical Disorders. American Psychiatric Publications. ISBN 0880489421. 
  15. ^ Dewhurst, K; Beard, A W (1970). "Sudden religious conversions in temporal lobe epilepsy.". The British journal of psychiatry : the journal of mental science 117 (540): 497–507. 
  16. ^ Waxman, Stephen G, MD; Geschwind, Norman, MD (1972). "The Interictal Behavior Syndrome of Temporal Lobe Epilepsy". Archives of General Psychiatry 32 (12): 1580–1586. Lay summary"Although the patient denied being religious, his writings contained numerous religious references, and some pages were adorned with religious symbols". 
  17. ^ Gerhard J. Luef (2008). "Epilepsy and sexuality". Seizure 17 (2): 127–130. doi:10.1016/j.seizure.2007.11.009. Lay summaryMen and women with epilepsy frequently complain, if asked, of sexual dysfunction and appear to have a higher incidence of sexual dysfunction than persons with other chronic neurologic illnesses. 
  18. ^ Harden, Cynthia L (2006). "Sexuality in men and women with epilepsy.". CNS spectrums 11 (8 Suppl 9): 13–8. PMID 16871133. 
  19. ^ L Tebartz van Elsta (et al.) (2003). "Psychopathological profile in patients with severe bilateral hippocampal atrophy and temporal lobe epilepsy: evidence in support of the Geschwind syndrome?". Epilepsy & Behavior 3 (4): 291–297. Lay summaryspecific symptoms that characterize the Geschwind syndrome like hypergraphia and hyposexuality might be pathogenically related to hippocampal atrophy. 
  20. ^ Rees, Peter M; Fowler, Clare J; Maas, Cornelis (2007). "Sexual function in men and women with neurological disorders.". Lancet 369 (9560): 512–25. PMID 17292771. 
  21. ^ Devinsky, Orrin; Vorkas, Charles; Barr, William (2006). "Personality disorders in epilepsy". Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment. Lippincott Williams & Wilkins. ISBN 078178591X.