Second edition

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252 Other major syndromes
Affective experiences may include anxiety, depression
or, rarely, euphoria. Anxiety and fear have been frequently
noted (Kennedy 1911; Macrae 1954a,b; Weil 1959;
Williams 1956) and may be quite severe, progressing to a
full anxiety attack (Alemayehu et al. 1995). In one case, the
seizures were characterized by anxiety, palpitations, dizziness,
and pallor (Rush et al. 1977), and in another the
patient was ‘afraid, perspired and did not want to be left
alone’ (McLachlan and Blume 1980). As might be
expected, some patients may become agoraphobic on the
basis of such ictal anxiety attacks: one patient, whose ictal
anxiety attacks lasted of the order of a minute, ‘went to the
emergency room’, and, fearful ‘she could have spells while
driving, at work, or in social situations . . . confined herself
to home’ (Weilburg et al. 1987). Ictal depressions ‘are characterized
by rather sudden let-down of mood and psychomotor
retardation . . . from simple listlessness and
apathy to agitated depression with suicidal attempts’ (Weil
1959). One patient’s ictal depressions were ushered in by
olfactory hallucinations, like ‘stuffed cabbage in a dirty
outhouse’, and could last for hours, during which the
patient ‘felt paralyzed inside and couldn’t follow through
an act’ (Weil 1955). Euphoria may occur (Williams 1956)
but in one case was followed, after 10–20 seconds, by an
intense depression (Mulder and Daly 1952). In another
case (Dewhurst and Beard 1970) the patient had, rather
than simple euphoria, a complex and ecstatic religious
experience: ‘he had a vision in which he was in the cockpit
of an aeroplane . . . the aircraft gained altitude and brought
him to a different land, a land of peace. He had no cares
and no burdens. He felt that the power of God was upon
him and changing him for the better’. The experience was
so powerful that the patient later converted from Judaism
to Pentecostalism.
Illusions may include macropsia, wherein objects
appear larger than they are, micropsia, wherein they
appear smaller, and various illusory movements of objects
(Heilman and Howell 1980; Russell and Whitty 1955).
Also possible are hyperacusis or hypoacusis, wherein
sounds appear louder or fainter, respectively, than they in
fact are. The supernumerary limb experience may also be
included here: one patient had such a strong ictal sense that
his arm was raised above his head that he asked his wife
to pull it down even though he acknowledged that he
could in fact see his actual arm at his side (Russell and
Whitty 1953).
Structured hallucinations are characterized by complex
visual or auditory experiences. One of Russell and Whitty’s
(1955) patients, wounded in the right occipital area, saw
‘stretcher bearers walking past and then the figures of
nurses whom he could recognize’, all in the left hemifield;
another, wounded in the right occipitoparietal area, ‘felt
that as if he was in a dream he was back in Khartoum during
the war. He saw and recognized friends around him’. In
another case (Sowa and Pituck 1989) the patient saw the
‘right side of people’s faces missing’ and ‘water coming out
of a clock’. Of interest, such ictal visual hallucinations may
also reappear in the patient’s dreams (Reami et al. 1991).
Although, in most cases, these complex visual hallucinations
occur in only one hemifield, they may at times spread
to appear in the entire visual field (Russell and Whitty
1955). Palinopsia may also occur, and one patient’s seizures
were characterized by seeing ‘non-existent pedestrians in an
empty street, having seen these people minutes before in
different surroundings’ (Muller et al. 1995). Autoscopy
may occur, in which patients hallucinate an image of themselves
(Brugger et al. 1994; Devinsky et al. 1989a). Auditory
structured hallucinations may consist of voices or music:
one patient heard the same song, repeated over and over
again (Wieser 1980).
Miscellaneous simple partial seizures
Various other signs and symptoms may occur on an ictal
basis, including prosopagnosia (Agnetti et al. 1978), asomatognosia
(Russell and Whitty 1955; So and Scauble
2004), and a combination of expressive aprosodia and
amusia (Bautista and Ciampetti 2003).
Other miscellaneous types of simple partial seizures
include unexplained urges, sexual experiences, involuntary
laughing or crying, forced thoughts and, rarely, delusions.
Inexplicable urges have included impulses to laugh
(Sturm et al. 2000) or to run (Strauss 1960).
Sexual experiences include strong sexual arousal (Erickson
1945) or orgasm (Reading and Will 1997; Ruff 1980).
Seizures characterized by involuntary laughing (‘gelastic’
seizures) or crying (‘dacrystic’ seizures) differ from
those characterized by ictal emotion (e.g., anxiety or
depression, as noted earlier) in that these patients,
although laughing or crying, do not experience any associated
mirth or sadness. One patient happened to see herself
in the mirror in the midst of a gelastic seizure and ‘was
puzzled by the discrepancy between her facial expression
and her feelings’ (Arroyo et al. 1993); in another case, the
smile accompanying the laughter reminded observers of a
‘ “toothpaste advertisement” smile’ (Lehtinen and Kivalo
1965). Dacrystic seizures manifest with a sad facial expression
and tears (Luciano et al. 1993; Marchini et al. 1994), in
one case capping off a sensory march that began in the left
leg, ascended to the left shoulder and was then succeeded
by weeping (Efron 1961).
Forced thoughts may occur and are quite similar to
obsessions (Mendez et al. 1996).
Delusions noted during simple partial seizures include
the Capgras phenomenon (delusion of doubles) (Kanemoto
1997) and a Schneiderian first rank symptom, namely a conviction
on the patient’s part ‘that his body is being controlled
by external forces’ (Mesulam 1981).
COMPLEX PARTIAL SEIZURES
Complex partial seizures (Delgado-Escueta et al. 1982;
Escueta et al. 1977; Golub et al. 1951; Holmes 1984;
Theodore et al. 1983) generally last of the order of one to