Affective Epilepsy

AFFECTIVE EPILEPSY, a name given by Bratz to the cases he observed together with Leubuscher, in which typical epileptic seizures and their equivalents occurred (most often under the influence of strong affects) not in epileptics but in psychopaths. These observations were later confirmed by Kraepelin, who described in detail that group of psychopathic personalities which serves as especially fertile soil for the emergence of the states described by Bratz. The main features of this group are extreme irritability, endogenous mood disorders, emotional instability and weakness of will, love for theatrical effects, pathological lying and a tendency toward fraudulent tricks. Persons subject to A.-e. are usually distinguished by good abilities, and even after many years they do not develop epileptic dementia; episodically they show very productive activity, however, they almost never hold to the level achieved, lose their position, and, sinking, sometimes fall to the lowest rungs of the social ladder: they become habitual drunkards and scandalmongers, lose the ability for regular activity and pass into the class of beggars, vagrants and swindlers. Bumke (Vitke) considers that the basis of the social ruin of these people lies in the constant fluctuations of their mental equilibrium: increased well-being and excessive claims are replaced by cowardly depression, regret for the harm caused and good intentions after a few hours turn into implacable hatred of society. Sometimes the bad mood of the patients also turns against themselves: they attempt suicide or accuse themselves of imaginary crimes. In states of affect they are, besides epileptic seizures, also subject to other brief disturbances of consciousness (dizziness, fainting, absence, puerilomanic attacks, brief hallucinatory and delusional outbursts). Very frequent are also attacks of dipsomania (see) and various forms of pathological intoxication. The seizures sometimes are distinguished by excessive duration and show a mixture of hysterical traits, generally inherent in these people. Related A.-e. groups also represent 'psychasthenic attacks' of Oppenheim (psychasthenische Krampfe) and 'reactive epilepsy' of Bonhoeffer. The question of the clinical position of affect-epilepsy is not entirely clear: it is beyond doubt that epileptic seizures may occur in all kinds of diseases and pathological states, in particular in the most diverse psychopaths, and also that in the latter case they are of psychogenic origin; but, on the other hand, part of the cases described as affect-epilepsy apparently must be referred to genuine epilepsy.