Possible epileptic origin of symptoms in a case exemplifying the sleeper kind of ‘limbic psychotic trigger reaction’

Abstract

Limbic psychotic trigger reaction (LPTR) includes paroxysmal, motiveless, unplanned felonies, all committed during flat affect, autonomic arousal and a fleeting de novo psychosis. It is considered as a form of non-convulsive behavioural seizures (NCBS). A transient limbic hyperactivation is probably implicated that impairs prefrontal monitoring but preserves memory for the acts. LPTR may, however, not be limited to felonies which have attracted forensic attention. There may exist many more ‘merely’ social misbehaviours, undetected and untreated as a ‘sleeper’ case. This kind of possible undetected LPTR cases, exemplified by a patient who suffers from paroxysmal hallucinations triggering her to attempt to commit infanticide, is presented herein. Our patient had repetitive occurrence of episodes and remission of the symptomatology after the administration of oxcarbazepine, facts that support the epileptic origin of the disorder.

Keywords:

• Limbic psychotic trigger reaction
• Motiveless criminal thoughts
• Memory retention
• Non-convulsive behavioural seizures
• Temporal lobe epilepsy