Because it may involve changes in behavior, epilepsy has traditionally straddled the divide between psychiatry and neurology. In ancient Greece, Hippocrates suggested that seizure disorders had a neurological basis, but it took nearly 2500 years for medical explanations to be generally accepted. In recent centuries, epilepsy has been mistakenly thought to represent a form of insanity and patients were often thought to be dangerous. Epilepsy (especially complex partial seizures) frequently has been associated with aggressive behavior in the minds of people in general and even in the medical literature.

It is now believed that most people with epilepsy are no more likely than others to act aggressively. A few do have episodes of aggressive behavior between seizures (interictal aggression). Researchers have proposed that there are syndromes of interictal behavior changes that can occur in people with epilepsy. The idea of such "interictal behavior disorders" remains a controversial subject, but certain behaviors have been recognized as part of the interictal behavior profile in many cases. Some suggest that aggression should be part of this behavioral profile.

Linking epilepsy with aggression has contributed to the stigma of the disorder, so any work that clarifies the nature of the relationship between these two factors has many potential benefits. One important question that has not been completely answered is what factors distinguish people with epilepsy who have episodes of interictal aggression and rage from those who do not.

The cognitive abilities known as executive functions may play a large role in differentiating people with behavioral changes that include aggression from those without such changes. Solving interpersonal conflicts and managing aggressive impulses requires the application of the planning, organizing, and integrating abilities that are a part of the executive functions. People who have problems with executive functions also tend to have a loss of inhibitions that affects many areas. Some experts argue that aggression due to problems with executive functions is largely due to the reduced ability to maintain control over the way changes in mood are expressed in behavior.

Deficits in executive functions have been documented among both children and adults who have a history of aggression. Changes in behavior including aggression have also been observed in people who have suffered injury to the frontal lobes of the brain, where many structures crucial to executive functions are located. It may be that individuals with epilepsy are at higher risk for aggressive behavior only when they also have impaired executive functions.

Topic Editor: Andres M. Kanner, M.D.
Last Reviewed:11/13/03