EPISODIC AGGRESSIVE BEHAVIOR IN CHILDREN WITH EPILEPSY

Objectives: To examine the profile of a subset of epilepsy patients presenting with episodic aggressive behavior.

Methods: Retrospective chart review analysis. We searched the databases of neurology and psychiatry to identify patients with episodic aggression, epilepsy and epilepsy syndromes, at the Hospital for Sick Children, Toronto, Canada between 1990 and 2003. Patients were included according to DSM 1V definition of episodic aggressive behavior.

Results: We found 27 patients consisting of 19 (70%) males and 8 (30%) females. Mean age at seizure onset was 3.1 years, ranging from 2 months to 9 years. Mean age at rage onset was 5.8 years, ranging from 2 to 12 years with a mean latency of 2.7 years, between seizure onset and rage onset. Twenty one (78%) patients had localization related epilepsy with 14 (78%) having left hemispheric foci. The etiology of epilepsy was found in 18 (67%) patients. The main causes were CNS infections (4), stroke (2), HIE (4), hippocampal sclerosis (3) and cerebral dysgensis/dysplasia (5). Co-morbidities like anxiety (5), ADHD (9), and self-mutilatory behavior (5) were frequently described in these subjects. Seventeen patients (63%) were aware of their aggressive behaviors and displayed feeling of remorse and guilt regarding their behaviors and 10 (37%) had amnesia. Six patients (22%) had surgical intervention for their intractable epilepsy and only 2 (33%) showed behavioral improvement at 18 months follow up. There were no cases associated with primary generalized epilepsy.

Conclusion: There was a clear-cut gender effect in episodic aggression that was detected in males more than females. The majority of patients had localization-related epilepsy. Seizure onset preceded the episodic aggressive behaviour. The early recognition of episodic rage will allow the clinician to institute measures to improve the behavioural management of such patients.