Intermittent catatonia and complex automatisms caused by frontal lobe epilepsy in dementia.

An 82-year-old man was admitted to the emergency department following bizarre behaviour. Police had noticed him driving erratically through his village. He did not stop when instructed, drove slowly home and appeared 'vacant' on questioning. While in hospital, he had approximately 15 episodes of catatonia, involving rigidity, negativism, mutism except echolalia and perseveration, automatic obedience and utilisation phenomena, lasting 2-20 min each. Between episodes, he was amnestic but otherwise well. Electroencephalography demonstrated bifrontal slowing with left-sided emphasis, and captured two focal onset partial seizures with the clinical correlate of the syndrome described above. He improved rapidly on levetiracetam and lorazepam, was discharged and received a diagnosis of dementia by his community mental health team shortly afterwards, based on chronic short-term memory loss, functional decline and MRI changes. This case has implications for our understanding of the neural correlate of catatonia, specifically frontal lobe pathway dysfunction.

Perseveration causes automatization of checking behavior in obsessive-compulsive disorder.

Repeated checking leads to reductions in meta-memory (i.e., memory confidence, vividness and detail), and automatization of checking behavior (Dek, van den Hout, Giele, & Engelhard, 2014, 2015). Dek et al. (2014) suggested that this is caused by increased familiarity with the checked stimuli. They predicted that defamiliarization of checking by modifying the perceptual characteristics of stimuli would cause de-automatization and attenuate the negative meta-memory effects of re-checking. However, their results were inconclusive. The present study investigated whether repeated checking leads to automatization of checking behavior, and if defamiliarization indeed leads to de-automatization and attenuation of meta-memory effects in patients with OCD and healthy controls. Participants performed a checking task, in which they activated, deactivated and checked threat-irrelevant stimuli. During a pre- and post-test checking trial, check duration was recorded and a reaction time task was simultaneously administered as dual-task to assess automatization. After the pre- and post-test checking trial, meta-memory was rated. Results showed that relevant checking led to automatization of checking behavior on the RT measure, and negative meta-memory effects for patients and controls. Defamiliarization led to de-automatization measured with the RT task, but did not attenuate the negative meta-memory effects of repeated checking. Clinical implications are discussed.

Automatism and driving offences.

Automatism is a rarely used defence, but it is particularly used for driving offences because many are strict liability offences. Medical evidence is almost always crucial to argue the defence, and it is important to understand the bars that limit the use of automatism so that the important medical issues can be identified. The issue of prior fault is an important public safeguard to ensure that reasonable precautions are taken to prevent accidents. The total loss of control definition is more problematic, especially with disorders of more gradual onset like hypoglycaemic episodes. In these cases the alternative of 'effective loss of control' would be fairer. This article explores several cases, how the criteria were applied to each, and the types of medical assessment required.

Estrutura, memória e a emergência da lei no Seminário sobre A carta roubada / Structure, memory and the emergence of the law in the Seminar on The purloined letter

Apesar de o Seminário sobre A carta roubada ser um dos escritos mais claros de Lacan, em uma parte importante e densa do texto um formalismo lógico-matemático sinteticamente apresentado torna a leitura de difícil acesso à maioria dos leitores. Além disto, hipóteses não explicitamente assumidas por Lacan neste trecho de seu escrito induzem o leitor a considerar como absolutos resultados que, infelizmente, possuem restrições quanto à generalização. Este artigo se propõe a analisar detidamente estes trechos obscuros e informais do texto e trazer à luz, não só as hipóteses assumidas por Lacan, mas, além disto, as conseqüências para sua própria teoria. Adicionalmente, uma discussão sobre os processos de auto-organização, segundo a moderna teoria da complexidade, se abre para atualizar as idéias de Lacan sobre a formação da estrutura do simbólico(AU)

Albeit the Seminar on The purloined letter is one of the clearest of the writings of Lacan, in a especially dense part of the text a logical-mathematical formalism makes the rationale difficult for the understanding of the majority of the readers. In addition, some hypothesis not explicitly assumed by Lacan in this part of his paper lead the reader to consider as absolute some conclusions that unfortunately can not be considered as such. This paper aims to analyse carefully these specific obscure parts of the text, bringing light, not only over Lacan’s subsumed hypothesis, but also on the consequences over his own theory. Some results from the theory of complexity, specially the self-organization phenomena, are used to update Lacan ideas about the genesis of the symbolic structure of the unconscious(AU)

Estrutura, memória e a emergência da lei no Seminário sobre A carta roubada / Structure, memory and the emergence of the law in the Seminar on The purloined letter

Apesar de o Seminário sobre A carta roubada ser um dos escritos mais claros de Lacan, em uma parte importante e densa do texto um formalismo lógico-matemático sinteticamente apresentado torna a leitura de difícil acesso à maioria dos leitores. Além disto, hipóteses não explicitamente assumidas por Lacan neste trecho de seu escrito induzem o leitor a considerar como absolutos resultados que, infelizmente, possuem restrições quanto à generalização. Este artigo se propõe a analisar detidamente estes trechos obscuros e informais do texto e trazer à luz, não só as hipóteses assumidas por Lacan, mas, além disto, as conseqüências para sua própria teoria. Adicionalmente, uma discussão sobre os processos de auto-organização, segundo a moderna teoria da complexidade, se abre para atualizar as idéias de Lacan sobre a formação da estrutura do simbólico

Albeit the Seminar on The purloined letter is one of the clearest of the writings of Lacan, in a especially dense part of the text a logical-mathematical formalism makes the rationale difficult for the understanding of the majority of the readers. In addition, some hypothesis not explicitly assumed by Lacan in this part of his paper lead the reader to consider as absolute some conclusions that unfortunately can not be considered as such. This paper aims to analyse carefully these specific obscure parts of the text, bringing light, not only over Lacan’s subsumed hypothesis, but also on the consequences over his own theory. Some results from the theory of complexity, specially the self-organization phenomena, are used to update Lacan ideas about the genesis of the symbolic structure of the unconscious

Peri-ictal vegetative symptoms in temporal lobe epilepsy.

We investigated peri-ictal vegetative symptoms (PIVS) in 141 patients with adult temporal lobe epilepsy (TLE) and assessed frequency, gender effect, and lateralizing value of peri-ictal autonomic signs. We recorded abdominal auras in 62%, goosebumps in 3%, hypersalivation in 12%, spitting in 1%, cold shivering in 3%, urinary urge in 3%, water drinking in 7%, postictal nose wiping (PNW) in 44%, and postictal coughing in 16%. At least one vegetative sign appeared in 86% of the patients. The presence of PIVS did not have a significant lateralizing value. PNW occurred in 52% of women and in 33% of men, whereas any PIVS was present in 93% of women and 77% of men. In summary, contradictory to previous studies, the presence of PIVS has no lateralizing value, which may be linked to a low frequency of occurrence of PIVS. PIVS, especially PNW, occurred more frequently in women, supporting the gender differences in epilepsy.

Epileptic consciousness: concept and meaning of aura.

This research is based on previous publications that have analyzed certain neuropsychological phenomena that always have the same characteristic clinical features: a vivid experience of sudden onset and automatic development, accompanied by an intense sensation of strangeness. When these automatisms are accompanied by only mental symptoms, the designation paroxysmal psychic automatisms (PPAs) is proposed, and they should be interpreted as partial seizures (PSs) with a psychic content whenever they clearly exhibit the four features of suddenness, passivity, intensity, and strangeness. This interpretation is based on the existence of a wealth of scientific literature indicating an overlap between PPAs and PSs; moreover, bibliographic reviews indicate that the clinical signs just defined as characterizing PPAs are precisely those defining the epileptic consciousness.

Impedidor labial para paciente com seqüela de lesão encefálica adquirida / Lip blocker use for patient with acquired encephalic lesion sequela

A espasticidade é um distúrbio freqüente nas lesões congênitas ou adquiridas do sitema nervoso central e afeta milhões de pessoas. O objetivo deste estudo foi demonstrar a importância da atuação do Cirurgião-dentista na promoção de tratamento adequado a um paciente com seqüela de lesão encefálica adquirida, com a confecção de um impedidor labial. Relatamos um caso de paciente em coma profundo há 130 dias, pós-parada cardiorrespiratória. Apresentava traumatismo recorrente em mucosa interna de lábio inferior, resultado do automatismo oral de natureza reflexa com mordida tônica e interposição do lábio inferior entre as superfícies incisais. Foi indicado um impedidor labial para atuar de forma a distanciar e proteger o lábio inferior dos arcos dentais, evitando a sua interposição entre as superfícies incisais. Foi realizada moldagem com silicona pesada, de condensação, em paciente semi-sentada, apresentando abertura bucal de 5 mm, e mantida com auxílio de garrote de borracha entre molares superiores e inferiores esquerdos. Foi feita a confecção de uma placa de acrílico interoclusal para estabilização da face vestibular do impedidor labial, em acetato. Instalado, respeitaram-se as inserções dos freios e bridas, com indicação de uso contínuo. Sete dias após a instalação do mesmo, notou-se evolução favorável no tocante à cicatrização do local anteriormente traumatizado. É de fundamental impotância a participação do Cirurgião-dentista na equipe transdiciplinar que atua em pacientes sequelados neurológicos, pois apenas este profissional pode entender e modificar a ação deletéria do dano neurológico em cavidade bucal.

Esquizofrenia y subjetividad / Schizophrenia and subjectivity

Existe actualmente cierto interés por las denominadas en la esquizofrenia. A lo largo de la historia de esta patología estos fenómenos han tomado forma a través de conceptos como despersonalización-desrealización, automatismo mental, trastornos del yo y autismo. Los autores se proponen revisar dichos síndromes y su asentamiento en el paradigma de la subjetividad entendida como autoconciencia, así como los límites que dicho paradigma encierra. Se concluye tratando de encuadrar este proceso dentro del asunto más amplio de una psicopatología concebida como técnica de producción de inteligibilidad (AU)

Recently, the group of symptoms known as of schizophrenia has raised a grouping interest. These phenomena have been shaped through concepts like depersonalization-derealization, mental automatism, disorders of the self and autism. The authors propose to review these syndromes, as well as their relationship with subjectivity understood as consciousness of the self (or self-awareness) and the shortcomings due to such a relationship. To finish, we will provide some hints into psychopathology understood as a technique of production of intelligibility which will hopefully help to provide a better grasp of the process describe above (AU)

Contralateral motor automatisms in neocortical temporal lobe epilepsy.

BACKGROUND: The lateralizing value of the motor automatisms is generally doubted in most patients with temporal lobe epilepsy. However, subgroup analysis of the seizures of temporal lobe origin suggests a role for motor automatisms in discriminating seizures of neocortical versus mesial temporal lobe origin. METHODS: Video-EEG of a patient with well-defined neocortical temporal lobe epilepsy was reviewed to assess the localizing value of motor automatisms. RESULTS: We report a patient with left upper extremity motor automatisms and clonic movements of the proximal left lower extremity with altered awareness as the sole manifestations of right temporal neocortical seizures. CONCLUSION: Early onset unilateral motor automatisms without dystonic posturing can localize the seizure origin to the contralateral temporal lobe neocortex.

[Ictal automatisms during partial complex seizures in 36 children]. / Iktalni automatizmi u toku parcijalnih kompleksnih napada kod 36 djece.

Partial complex seizures are relatively frequent type of epileptic seizures. These attacks are having aura in 60% of cases, that can be vegetative, motor, sensor or psychological one. Important is aura in the form of uncinatus seizures (unpleasant odor), because we must exclude tumor of temporal region in these patients. Altered consciousness comes after aura, patient has opened eyes, face can be pale or red, and automatism appear, in the form of different movements. These automatisms are often considered insignificant by parents or eyewitnesses. There is often misdiagnosis of this type of seizures, because only about 20% of standard EEG recordings find specific epileptic grapho-elements. Therapy of these seizures is difficult, with the success in only 50% of cases. Ictal automatisms were tested in the group of 36 children with partial complex seizures aged 4 to 17 years. Duration of epilepsy was 1 to 5 years. All patients had proved diagnosis of partial complex seizures, clinically and on electroencephalography, CT scan and MRI in medically intractable seizures. Eleven patients were videotaped during the attack. All patients had questionnaire filled by parents, about automatisms. Thirty-four patients (94.4%) had ictal automatisms, and 2 with epileptic focus in frontal region did not. Some patients had different types of automatisms. Most frequent ones were mimicking (15.19%), sitting-standing up (10.76%), swinging (8.23%), swallowing (7.59%) etc. It can be concluded that automatisms are almost obligatory part of partial complex seizure, and their registration is essential for correct diagnosis and treatment of these seizures.

Association of ipsilateral motor automatisms and contralateral dystonic posturing: a clinical feature differentiating medial from neocortical temporal lobe epilepsy.

BACKGROUND: Clinical features that may help to differentiate medial temporal lobe epilepsy (MTLE) from neocortical temporal lobe epilepsy (NTLE) are lacking. OBJECTIVE: To investigate the localizing and lateralizing value of the association of ipsilateral motor automatisms and contralateral dystonic posturing in patients with medically refractory temporal lobe epilepsy. PATIENTS AND METHODS: Videotapes of 60 patients with well-defined MTLE, NTLE, or both were reviewed to assess the presence and the localizing value of unilateral dystonic posturing associated with motor automatisms. RESULTS: Twenty-eight of the 60 patients exhibited unilateral dystonic posturing. This sign was observed in patients with MTLE and NTLE. It was mostly contralateral to the seizure focus in patients with MTLE and exclusively ipsilateral in patients with NTLE. Unilateral motor automatisms occurred in 26 of the 60 patients with MTLE or NTLE. It was predominantly ipsilateral to the seizure focus in patients with MTLE and exclusively contralateral in patients with NTLE. The association of ipsilateral motor automatisms and contralateral dystonic posturing was found in 14 patients with MTLE but in none of the patients with NTLE. Two patients who had medial and neocortical seizure onset also exhibited this clinical feature. This association was not significantly correlated with the postoperative outcome in patients with MTLE. CONCLUSIONS: The association of ipsilateral motor automatisms and contralateral dystonic posturing may help to differentiate MTLE from NTLE with a reliable lateralizing value. This clinical association may reflect a specific pattern in the spread of the ictal discharge.

[Structure of mental disorders and diagnostic criteria. On Clerambault syndrome]. / Structuration du trouble mental et critères diagnostiques. A propos du syndrome de Clérambault.

Observation of a patient followed during 25 years, which indicate Clérambault'syndrome of mental automatism, is reported. The systemal method makes it possible to confirm the structure of this complex pathological system and to set limits to the current diagnostic criteria.

[Pedaling automatism in atypical West syndrome: a case report].

A seven-month-old girl with atypical West syndrome with pedaling automatism was reported. She started to have early infantile epileptic encephalopathy with suppression-burst (EIEE) at age 14 days followed by infantile spasms at 3 months of age. She began to have spasms with automatism at 4 month, mainly consisting of pedaling movements of both feet associated with tonic spasms of upper extremities and writhing of trunk. Ictal EEG showed irregular slow waves with occasional spikes predominantly over the right hemisphere mixed with artifacts. Interictal EEG during sleep showed suppression-burst patterns. Cerebral atrophy and microcephaly were revealed on brain CT, immature myelination on MRI and decreased blood flow in the frontal, temporal, and parietal lobes on the right on PET scan. Pedaling automatism is rare in infancy and its clinical significance was discussed in relation to West syndrome and complex partial seizures.

A hypergraphic syndrome of automatic writing, affective disorder, and temporal lobe epilepsy in two patients.

Two patients are described who wrote complex textual material suddenly, automatically, and without volitional control. Each met DSM-III criteria for a major affective disorder, had clinical and electrophysiologic temporal lobe epilepsy, absence spells, episodic expressive aphasia, and a history of traumatic loss of consciousness. The episodes of automatic writing met the criteria for ictal events. These patients may have experienced an ictal analogue of interictal hypergraphia. The behavioral neurologic features of this syndrome are discussed in relation to its clinical presentation and known disorders of writing.