Book Review

Seized

N Engl J Med 1994; 330:1463May 19, 1994

Article

Seized
By Eve LaPlante. 254 pp. New York, HarperCollins, 1993. $20. ISBN: 0-06-016673-8

The idea of an articulate nonphysician addressing the multifaceted topic of temporal-lobe epilepsy is an interesting one, since physicians are not always the best able to communicate concepts to the lay public. This book is designed to provide insights by drawing from history and the experiences of individual patients, physicians, and psychologists. Stylistically the chapters are well written, the index is complete, and an interesting reference list is provided.

The spectrum of manifestations of temporal-lobe epilepsy is broad and can include a variety of unusual phenomena such as sensations of deja vu, depersonalization, fear, perceptual changes, and disorientation. Throughout the book, however, the author errs in attributing too many episodic and behavioral characteristics to temporal-lobe epilepsy. In describing the temporal-lobe seizures of several patients, she describes behavioral alterations lasting many hours as seizure phenomena. Although complex partial status epilepticus can certainly occur, the typical partial seizure arising from the temporal lobe lasts just minutes and is followed by a brief postictal period.

Much of the book focuses on providing support for the concept of an epileptic personality. Among others, the late Norman Geschwind felt that there was an association between epilepsy and specific personality traits. In patients with temporal-lobe epilepsy, this epileptic personality is said to include such characteristics as hypergraphia, viscosity (tendency to repetition), religiosity, aggression, and altered sexuality. Although some people with temporal-lobe epilepsy may possess some of these traits, the concept of a typical epileptic personality is very controversial and has been refuted by a number of studies.

The book includes interesting historical vignettes -- some brief, some more extensive -- detailing the lives of various artists and authors thought to have had epilepsy. Vincent van Gogh, Fyodor Dostoevsky, Gustave Flaubert, and Edgar Allan Poe are among those discussed as having had epilepsy. To support the hypothesis that temporal-lobe epilepsy produces a broad range of manifestations, many of the characteristics of these artists are attributed to their epilepsy. In the case of van Gogh, LaPlante would have us believe that his creative genius as well as his dysphoria resulted from, rather than coexisted with, his epilepsy. In fact, it is thought that van Gogh did have epilepsy but also suffered from alcohol abuse, periodic digitalis toxicity, and a major affective disorder. Each of these disorders may have contributed to and provided insights for his art, but it is unlikely that any of them actually produced his genius.

The chapter on intervention mentions anterior temporal lobectomy as a therapy for refractory temporal-lobe epilepsy. The procedure is described, however, as controversial, rather than as an established treatment. The outcome statistics mentioned are worse than those in major epilepsy-treatment centers. Indeed, the majority of the chapter on intervention describes selected unfortunate experiences with frontal leukotomy and bilateral amygdalectomy, procedures used in the past in an attempt to control behavior, not seizures. Although the author acknowledges that these procedures are now appropriately in disfavor, the net result of the chapter is to blur the boundaries between psychosurgery and seizure surgery and to discredit both.

The book jacket describes this work as “an invaluable resource for anyone whose life has been touched by epilepsy.” Unfortunately, I cannot recommend it for patients with epilepsy, their families, or nonphysicians -- the very audience for whom this book was intended. The inaccuracies and the strong bias of the author present such a skewed portrait of the person with temporal-lobe complex partial seizures that many more misconceptions about temporal-lobe seizures will be created than resolved. The neurologist or epileptologist with a knowledge of the literature may enjoy some of the historical profiles and vignettes from patients' histories and may be able to be appropriately critical of the author's viewpoint.

Gregory K. Bergey, M.D.
University of Maryland School of Medicine, Baltimore, MD 21201