Descriptive Psychopathology: The Signs and Symptoms of ...

195 Chapter 7: Disturbances of motor function118 The motor weakness is explained as a combination of two factors. First, right-sided lesionsare associated with some neglect that is expressed as “weakness”. Second, the bend of theinternal capsule carrying crossed motor fibers is in the anterior part of the parietal lobe,and lesions near or in it can cause motor weakness.119 Pehlivanturk and Unal (2002).120 Schrag et al. (2004).121 Keane (1989).122 Groppel et al. (2000).123 Simon et al. (2004).124 Vignette provided by Aida Rjepaj, MD, who was a PGY-2 resident at the time. The patienthad partial complex seizures with their origin in frontal brain regions as they wereassociated with bilateral upper limb movements and forced speech. Of patients withpartial complex fits, 40–60% will have elevated prolactin levels as the limbic seizure drivesthe hypothalamic–pituitary system. The peak level is seen about 20min after the seizureends and is cleared within the next 5min providing a very narrow window of opportunityto obtain this diagnostically useful information (Chen et al., 2005).125 Green and Devinsky (1992).126 Factor et al. (1995); Stone et al. (2004).127 Kotagal et al. (2002). These authors identified a seizure disorder in 34% of patientsdiagnosed with non-epileptic seizure events. Jedrzejczak et al. (1999), in a study of over1000 patients assessed for possible epilepsy, found 85 (7.8%) to have non-epilepticseizures. Of these, 37 (42%) had epileptic seizures at other times.128 Kellinghaus et al. (2004).129 Krem (2004).130 Feinstein et al. (2001).131 Wirthrington and Wynn-Parry (1985).132 Monday and Jankovic (1993).133 Fernandez-Alvarez (2005).134 Fahn (1993).135 Factor et al. (1995); Lang (2006).136 Wirthrington and Wynn-Parry (1985).137 Krem (2004).138 Flor-Henry et al. (1981).139 Mailis-Gagnon et al. (2003).140 Starkstein et al. (1992); Dolan (2002).141 Damasio (2003).142 Black et al. (2004).143 Marshall et al. (1997).144 Yazici and Kostakoglu (1998); Vuilleumier (2005); Fink et al. (2006).145 Ron (2001).146 Vuilleumier (2005).147 Athwal et al. (2001).148 Vuilleumier (2005).