Persistent genital arousal disorder associated with functional hyperconnectivity of an epileptic focus.

Persistent Genital Arousal Disorder (PGAD) refers to the experience of persistent sensations of genital arousal that are felt to be unprovoked, intrusive and unrelieved by one or several orgasms. It is often mistaken for hypersexuality since PGAD often results in a high frequency of sexual behaviour. At present little is known with certainty about the etiology of this condition. We described a woman with typical PGAD symptoms and orgasmic seizures that we found to be related to a specific epileptic focus. We performed a EEG/MEG and fMRI spontaneous activity study during genital arousal symptoms and after the chronic administration of 300 mg/day of topiramate. From MEG data an epileptic focus was localized in the left posterior insular gyrus (LPIG). FMRI data evidenced that sexual excitation symptoms with PGAD could be correlated with an increased functional connectivity (FC) between different brain areas: LPIG (epileptic focus), left middle frontal gyrus, left inferior and superior temporal gyrus and left inferior parietal lobe. The reduction of the FC observed after antiepileptic therapy was more marked in the left than in the right hemisphere in agreement with the lateralization identified by MEG results. Treatment completely abolished PGAD symptoms and functional hyperconnectivity. The functional hyperconnectivity found in the neuronal network including the epileptic focus could suggest a possible central mechanism for PGAD.

[The elderly subject and social violence: the body as a factor in communication]. / Le sujet âgé et la violence sociale: le corps comme facteur de communication.

The social inferiority of an elderly person stems from his physical inferiority--actual or alleged but always possible. And yet this "inferior" body is paradoxically hypertrophic: at first it masks the person, then takes up its space until it negates it. Hence, an elderly person is not only a body but a lonely body. In his relations with other people, his body becomes a receiver, a receptacle and a source of communication. Social violence underlies relations with elderly people: such violence may be deceptive, widespread and continuous or, on the other hand, manifest, episodic and conspicuous. In the first case it may be a way of assigning subalternate roles to them in relation to the efficiency expected of them or a way of mythologizing their condition as one of pseudo-happiness. In the second case is generally relates to assaults, thefts, bag-snatching, etc. In any case, however, communication with them entails violence: their body perceives this and reacts to it. This is why their body's language is violent: their body cries out, it is stunned and it is acted upon (even--and unavoidably--in relations with a therapist).