Abstracts concerning déjà experiences associated with neurological pathology (primarily epilepsy)
The abstracts are listed in reverse chronological order: the more recent ones are listed first.
In the older literature, there were other terms used for déjà vu: paramnesia, fausse reconnaissance (French), Erinnerungsfälschung or -täuschung (German) and so on. You'll encounter these if you scroll down to the early abstracts (i.e., before 1910 or so).
For those that were published without an abstract (or for which we could not locate one) we have tried to provide some information from the paper or book. We are sure we have not done justice to many of them and would be grateful for suggestions for amendment or correction. There are still many that we have not been able to find abstracts for or make comments on.
To find an author, year, or a specific word, perform a search using CTRL-F.
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Paraneoplastic Neurologic Syndromes
Graber JJ
Continuum (Minneapolis, Minnesota). 29(6):1779-1808, 2023.
PMID: 38085898 DOI: 10.1212/CON.0000000000001357
Abstract
Objective: Progress is ongoing in understanding paraneoplastic neurologic disorders, with new syndromes and antibodies being described and more detailed evidence available to guide workup for diagnosis and treatment to improve outcomes. Many excellent reviews have summarized the molecular features of different antibodies, but this article emphasizes the clinical features of each syndrome that may help guide initial diagnosis and treatment, which often should occur before an antibody or cancer is found to confirm the diagnosis.
Latest developments: Recent findings include updated diagnostic criteria with validated sensitivity and specificity, discovery of novel antibodies, and clinical findings that increase the likelihood of an underlying paraneoplastic disorder. Suggestive syndromes that have been recently identified include faciobrachial dystonic seizures and pilomotor auras in anti-leucine-rich glioma inactivated protein 1 encephalitis, extreme delta brush on EEG in N-methyl-d-aspartate (NMDA)-receptor encephalitis, déjà vu aura in anti-glutamic acid decarboxylase 65 (GAD65) encephalitis, and sleep disturbances in several disorders. In addition, there is confirmed utility of brain positron emission tomography (PET) and CSF markers, including carcinoembryonic antigen and oligoclonal bands, as well as improved tests for the presence of leptomeningeal cancer cells in CSF. Associations of cancer immunotherapies with paraneoplastic syndromes and herpes simplex virus encephalitis (and COVID-19) with NMDA-receptor encephalitis have been described.
Essential points: All neurologists should be aware of advances regarding paraneoplastic neurologic syndromes, as patients can present with a wide variety of neurologic symptoms and earlier diagnosis and treatment can improve outcomes.
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Surgical Management of Temporal Lobe Epilepsy Secondary to Epidermoid Cysts: A Case Report With Review of the Literature
Torres C.S.O.1, Efe I. E.2, Ramirez M.d.J.E.3, Juarez E.D.4, Calderon A.R.4, Nurmukhametov R.3, Campero A.5, Pena I.J.R.6, Montemurro N.7
1 Neurosurgery, National Autonomous University of Mexico, General Hospital, Mexico, MEX.
2 Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, DEU.
3 Neurosurgery, Peoples' Friendship University of Russia, Moscow, RUS.
4 Neurosurgery, National Autonomous University of Mexico, Mexico, MEX.
5 Neurosurgery, Hospital Ángel C. Padilla, San Miguel de Tucumán, ARG.
6 Neurooncology, Royal Melbourne Hospital, Melbourne, AUS.
7 Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, ITA.
Cureus. 15(9): e45360, 2023
doi: 10.7759/cureus.45360. eCollection 2023 Sep.
PMID: 37849566 PMCID: PMC10577610 DOI: 10.7759/cureus.45360
Abstract
Epidermoid cysts represent roughly 1% of all intracranial tumors. They are frequently located in the cerebellopontine angle but rarely extend to the supratentorial brain. Epilepsy is an extremely uncommon manifestation of this neoplasm. We suggest the surgical management of a 35-year-old male who presented with a six-month history of intractable temporal lobe epilepsy. His seizures were characterized by a focal onset in the form of déjà vu experiences, followed by a secondarily generalized tonic-clonic seizure. Imaging revealed a heterogeneous cystic mass in the right cerebellopontine angle, extending supratentorially causing a mass effect on the mesial temporal region. Gross total resection was achieved through a combined subtemporal-retrosigmoid approach. Histopathology revealed an epidermoid cyst. The patient was entirely seizure-free at the three-month follow-up. Epidermoid cysts may present with epileptic seizures. Seizure freedom can be achieved with surgical management in most cases. The patient's symptoms, imaging findings, and epileptogenic focus must be considered to select the appropriate surgical strategy.
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A novel BRAF::PTPRN2 fusion in meningioma: a case report
Sadagopan NS1, Nandoliya KR1, Youngblood MW1, Horbinski CM1,2, Ahrendsen JT2, Magill ST3
1 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA.
2 Department of Pathology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Avenue, Ward 3-140, Chicago, IL, 60611, USA.
3 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA.
Acta Neuropathol Commun. 2023 Dec 8;11(1):194, 2023
PMID: 38066633 PMCID: PMC10704634 DOI: 10.1186/s40478-023-01668-w
Abstract
Gene fusion events have been linked to oncogenesis in many cancers. However, gene fusions in meningioma are understudied compared to somatic mutations, chromosomal gains/losses, and epigenetic changes. Fusions involving B-raf proto-oncogene, serine/threonine kinase (BRAF) are subtypes of oncogenic BRAF genetic abnormalities that have been reported in certain cases of brain tumors, such as pilocytic astrocytomas. However, BRAF fusions have not been recognized in meningioma. We present the case of an adult female presenting with episodic partial seizures characterized by déjà vu, confusion, and cognitive changes. Brain imaging revealed a cavernous sinus and sphenoid wing mass and she underwent resection. Histopathology revealed a World Health Organization (WHO) grade 1 meningioma. Genetic profiling with next generation sequencing and microarray analysis revealed an in-frame BRAF::PTPRN2 fusion affecting the BRAF kinase domain as well as chromothripsis of chromosome 7q resulting in multiple segmental gains and losses including amplifications of cyclin dependent kinase 6 (CDK6), tyrosine protein-kinase Met (MET), and smoothened (SMO). Elevated pERK staining in tumor cells provided evidence of activated mitogen-activated protein kinase (MAPK) signaling. This report raises the possibility that gene fusion events may be involved in meningioma pathogenesis and warrant further investigation.
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Oh it's me again: Déjà vu, the brain, and self-awareness
Zorns S, Sierzputowski C, Pardillo M, Keenan JP
Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ, USA
www.cognitiveneuroimaginglab.com.
Behav Brain Sci. Nov 14:46:e383, 2023.
doi: 10.1017/S0140525X23000201. PMID: 37961797
Abstract
Déjà vu and involuntary autobiographical memories (IAMs) are differentiated by a number of factors including metacognition. In contrast to IAMs, déjà vu activates regions associated with self-awareness including the right dorsolateral prefrontal cortex.
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Musicogenic epilepsy in paraneoplastic limbic encephalitis: a video-EEG case report
Morano A.1, Orlando B.1, Fanella M.1 2, Irelli E. C.1, Colonnese C.3, Quarato P.4, Giallonardo A. T.1, Di Bonaventura C.1
1 Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome.
2 Neurology Unit, Ospedale "San Camillo de' Lellis" Rieti.
3 Neuroradiology Unit, IRCCS "Neuromed", Pozzilli, IS.
4 Epilepsy Surgery Unit, IRCSS "Neuromed", Pozzilli, IS.
Epileptic Disorders July 10, 2023
PMID: 37430419 doi: 10.1002/epd2.20111. Online ahead of print.
Abstract
Musicogenic epilepsy (ME), a peculiar form of reflex epilepsy, represents a neurological rarity and yet another demonstration of the extraordinary power of music on the human brain. Despite the heterogeneity of the reported musical triggers, the patients' emotional response to music is thought to play a crucial role in provoking seizures. Accordingly, the mesial temporal structures (especially of the non-dominant hemisphere) appear most involved in seizure generation, although a more complex fronto-temporal epileptogenic network was documented in some cases. Autoimmune encephalitis has been recently included among the many possible etiologies of ME thanks to few reports of music-induced seizures in patients with anti-glutamic acid decarboxylase 65 antibodies. Here we describe the case of a 25-year-old man, with long-term music education, who suffered from drug-resistant temporal lobe epilepsy following seronegative limbic encephalitis related to non-Hodgkin lymphoma. Along with spontaneous events, the patient also developed musicogenic seizures later in the disease course. After detecting five music-induced episodes via 24-h ambulatory EEG, we performed a prolonged video-EEG monitoring during which the patient presented a right temporal seizure (characterized by déjà-vu, piloerection and gustatory hallucinations) while listening to a hard-rock song (never heard before) through headphones. This observation allowed us to confirm the provoking effect of music on our patient's seizures, despite the lack of any emotional drive, which suggests that a "cognitive" trigger was more likely in this case. Our report further highlights that autoimmune encephalitis should be investigated as a novel potential cause of musicogenic epilepsy, regardless of autoantibody status.
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[Personalized approach in the diagnostics and treatment of symptomatic epilepsy with déjà vu seizures] [Article in Russian]
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. (Special Issue 1):887-891, 2023.
doi: 10.32687/0869-866X-2023-31-s1-887-891 PMID: 37742269.
Khomutov V.E.1, Kolesnikova I.V.1, Mingazova E.N.2, Bespyatykh Yu A1,3,4
1 Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine, 119435, Moscow, Russia.
2 N. A. Semashko National Research Institute of Public Health, 105064, Moscow, Russia,
3 N. A. Semashko National Research Institute of Public Health, 105064, Moscow, Russia.
4 Dmitry Mendeleev University of Chemical Technology of Russia, 125047, Moscow, Russia.
Abstract
The phenomenon of déjà vu (DV) is of interest, occurring in 97% of healthy individuals, while DV can be a manifestation of a number of pathologies, such as Charles Bonnet syndrome, depression, schizophrenia, or temporal lobe epilepsy. Most cases of DV type epiphenomena are associated with hippocampal sclerosis, while up to 90% of patients with mesial temporal sclerosis are drug resistant. Despite the success of pharmacotherapy, the frequency of «uncontrolled» epilepsy in industrialized countries that adhere to modern standards of treatment is from 30 to 40%, and this percentage is higher among patients with symptomatic and cryptogenic forms than among patients with idiopathic epilepsy (respectively: 40% and 26%). In turn, when studying the DV phenomenon and choosing a therapy strategy, it is necessary to establish its origin, determine its clinical significance (whether it is initially pathological or not), and the need for treatment. During the analysis of exome data, a search was made for substitutions in genes associated with arteriovenous malformations, both with autosomal dominant and autosomal recessive types of inheritance. The genes KRIT1, RASA1, IL6, FAM58A, GLML, EPHB4, CCM2, and ELMO2 were analyzed especially carefully. The analysis of genetic data is of great importance in the aspect of preventing cerebrovascular accidents, at the same time, in order to obtain reliable and significant results, in addition to time and financial costs, examination of relatives is also required. Meanwhile, this fact does not mean that every patient needs to conduct a genetic study. The paper presents detailed instructions for supplementing anamnestic information, as well as the results of personalized instrumental and laboratory diagnostics, which made it possible to carry out timely correction of therapy and achieve a prolonged positive effect.
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Familial mesial temporal lobe epilepsy: clinical spectrum and genetic evidence for a polygenic architecture
Harris, R. V.1, Oliver K. L.1,2,3, Perucca P.1,4,5,6,7, Striano P.8,9, Labate A.10, Riva A.8,9, Grinton B. E.1, Reid J,1, Hutton J.1,5,6,7, Todaro M.5,6,7, O'Brien T. J.5,6,7, Kwan P.5,6,7, Sadleir L. G.11, Mullen S. A.1,4, Dazzo E.12, Crompton D. E.1,13, Scheffer I. E.1,4,14,15, Bahlo M.2,3, Nobile C.12, Gambardella A.16, Berkovic S. F.1,4
1. Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia.
2. Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.
3. Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia.
4. Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, Victoria, Australia.
5. Departments of Medicine and Neurology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
6. Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.
7. Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
8. IRCCS Istituto Giannina Gaslini, member of ERN-Epicare, Genoa, Italy.
9. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
10. Neurophysiopatology and Movement Disorders Clinic, University of Messina, Italy.
11. Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
12. Neuroscience Institute, National Research Council of Italy, Padua, Padova, Italy.
13. Department of Neurology, Northern Health, Epping, Victoria, Australia.
14. Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
15. Murdoch Children's Research Institute and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia.
16. Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Annals of Neurology. (Online ahead of print.) 8, 2023
PMID: 37597255 DOI: 10.1002/ana.26765
Abstract
Objective: Familial mesial temporal lobe epilepsy (FMTLE) is an important focal epilepsy syndrome; its molecular genetic basis is unknown. Clinical descriptions of FMTLE vary between a mild syndrome with prominent déjà vu to a more severe phenotype with febrile seizures and hippocampal sclerosis. We aimed to refine the phenotype of FMTLE by analyzing a large cohort and asked whether common risk variants for focal epilepsy and/or febrile seizures, measured by polygenic risk scores (PRS), are enriched in individuals with FMTLE.
Methods: We studied 134 families with ≥2 first or second-degree relatives with temporal lobe epilepsy (TLE), with clear mesial ictal semiology required in at least one individual. PRS were calculated for 227 FMTLE cases, 124 unaffected relatives and 16,077 population controls.
Results: Age of FMTLE onset ranged from 2.5-70 years (median = 18, IQR = 13-28 years). The most common focal seizure symptom was déjà vu (62% of cases), followed by epigastric rising sensation (34%), and fear or anxiety (22%). The clinical spectrum included rare cases with drug-resistance and/or hippocampal sclerosis. FMTLE cases had a higher mean Focal Epilepsy PRS than population controls (OR 1.24, 95% CI 1.06, 1.46, p = 0.007); in contrast, no enrichment for the Febrile Seizure PRS was observed.
Interpretation: FMTLE is a generally mild drug-responsive syndrome with déjà vu being the commonest symptom. In contrast to dominant monogenic focal epilepsy syndromes, our molecular data support a polygenic basis for FMTLE. Furthermore, the PRS data suggest that sub-genome-wide significant focal epilepsy GWAS SNPs are important risk variants for FMTLE. This article is protected by copyright. All rights reserved.
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Dissociation in patients with epilepsy and functional seizures: A narrative review of the literature
Cassady M.1, Baslet G.2
Seizure 110:220-230, 2023
PMID: 37433243 doi: 10.1016/j.seizure.2023.06.020. Online ahead of print.
1 Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address:
2 Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
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Epilepsy and syncope - A case report and narrative review of arrhythmias connected to temporal lobe epilepsy
Bianco M1, Breviario S2, Fraccalini T3, Ferri R4, Biolè C5, Destefains P5, Varalda G5, Boccuzzi A3, Chinaglia A5
1 Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy. Electronic address:
2 Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
3 Emergency Medicine Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
4 Neurology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
5 Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
Journal of Electrocardiology 73:76-78, 2022.
doi: 10.1016/j.jelectrocard.2022.06.001. Online ahead of print.
PMID: 35716424 DOI: 10.1016/j.jelectrocard.2022.06.001
Abstract
We present the case of a 28-years-old male presenting to the Emergency Department for relapsing episodes of "déjà vu" and syncope. After a diagnostic workup by a multidisciplinary team, the simultaneous EEG and ECG monitoring showed an asystole associated with EEG anomalies in right fronto-temporal region of the brain. The brain MRI revealed an ischemic lesion concordant with EEG anomalies. In the suspicion of an ictal asystole, we decided not to implant a permanent pacemaker as the first line therapy but started a targeted anti-epileptic therapy. No more syncopal episodes nor dysrhythmias occurred during recovery and almost two years follow-up.
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Relationship between déjà vu experiences and recognition-memory impairments in temporal-lobe epilepsy
Martin CB1,2, Mirsattari SM3, Pruessner JC4, Burneo JG3, Hayman-Abello B3, Köhler S1,5
1 The Brain and Mind Institute and Department of Psychology, University of Western Ontario, London, Canada.
2 Department of Psychology, University of Toronto, Toronto, Canada.
3 Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre and University of Western Ontario, London, Canada.
4 Department of Psychology, University of Konstanz, Konstanz, Germany.
5 Rotman Research Institute, Baycrest Centre, Toronto, Canada.
Memory 29(7):884-894, 2021.
doi: 10.1080/09658211.2019.1643891. PMID: 31339436 Epub 2019 Jul 24.
Abstract
Déjà vu is characterised by feelings of familiarity and concurrent awareness that this familiarity is wrong. Previous neuropsychological research has linked déjà vu during seizures in individuals with unilateral temporal-lobe epilepsy (uTLE) to rhinal-cortex abnormalities, and to recognition-memory deficits that selectively affect familiarity assessment. Here, we examined whether bilateral TLE patients with déjà vu (bTLE) show a similar pattern of performance. Using two experimental tasks, we found that bTLE patients exhibit deficits not only for familiarity but also for recollection. Relative to uTLE, this broader impairment also involved hippocampal abnormalities. Our findings confirm rhinal-cortex contributions to the generation of false familiarity in déjà vu that parallel its contributions to familiarity on recognition-memory tasks. While they do not rule out a role for recollection in identifying this familiarity as wrong, the deficits observed in bTLE patients weigh against the notion that any such role is necessary for déjà vu to occur.
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Insights into déjà vu: Associations between the frequency of experience and amplitudes of low-frequency oscillations in resting-state fMRI
Zatloukalova, E.1, Mikl, M.2, Shaw, D. J.2, 3, Marecek, R.1,2, Sakalosova, L.1,2, Kuratkova, M.1,2, Mitterova, K.1,2, Sklenarova, B.1, Brazdil, M.1,2
1 Brno Epilepsy Center, Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
2 Central European Institute of Technology; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
3 School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom.
European Journal of Neuroscience 2021 Dec 14.
doi: 10.1111/ejn.15570. Online ahead of print.
PMID: 34907615 DOI: 10.1111/ejn.15570
Abstract
The phenomenon of déjà vu (DV) has intrigued scientists for decades, yet its neurophysiological underpinnings remain elusive. Brain regions have been identified in which morphometry differs between healthy individuals according to the frequency of their DV experiences. This study built upon these findings by assessing if and how neural activity in these and other brain regions also differ with respect to DV experience. Resting-state fMRI was performed on 68 healthy volunteers, 44 of whom reported DV experiences (DV group) and 24 who did not (NDV group). Using multivariate analyses, we then assessed the (fractional) amplitude of low-frequency fluctuations (fALFF/ALFF), a metric that is believed to index brain tissue excitability, for 5 discrete frequency bands within sets of brain regions implicated in DV and those comprising the default mode network (DMN). Analyses revealed significantly lower values of fALFF/ALFF for specific frequency bands in the DV relative to the NDV group, particularly within mesiotemporal structures, bilateral putamina, right caudatum, bilateral superior frontal cortices, left lateral parietal cortex, dorsal and ventral medial prefrontal cortex, and the posterior cingulate cortex. The pattern of differences in fALFF/ALFF measures between the brains of individuals who have experienced DV and those who have not provides new neurophysiological insights into this phenomenon, including the potential role of the DMN. We suggest that the erroneous feeling of familiarity arises from a temporary disruption of cortico-subcortical circuitry together with the upregulation of cortical excitability.
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Subjective distinguishability of seizure and non-seizure Déjà Vu: A case report, brief literature review, and research prospects
Cleary, A. M.1, Neisser, J.2, McMahan, T.3, Parsons, T. D.4, Alwaki, A.5, Okada, N.5, Vosoughi, A.5, Kheder, A.6, Drane, D. L.7, Pedersen, N. P.8
1 Department of Psychology, Colorado State University, Fort Collins, CO 80525, USA.
2 Department of Philosophy, Grinnell College, 1120 Park St, Grinnell, IA 50112, USA.
3 Department of Learning Technologies, University of North Texas, Denton, TX 76203, USA; Center for Affective Neurotechnologies (iCAN), University of North Texas, Denton, TX 76203, USA.
4 Center for Affective Neurotechnologies (iCAN), University of North Texas, Denton, TX 76203, USA.
5 Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA.
6 Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA.
7 Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA 98105, USA.
8 Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA; Department of Biomedical Engineering, The Georgia Institute of Technology, Atlanta, GA 30332, USA. Electronic address:
Epilepsy Behavior Nov 1;125:108373, 2021.
doi: 10.1016/j.yebeh.2021.108373. Online ahead of print.
PMID: 34735965
Abstract
Roughly two-thirds of all people report having experienced déjà vu-the odd feeling that a current experience is both novel and a repeat or replay of a previous, unrecalled experience. Reports of an association between déjà vu and seizure aura symptomatology have accumulated for over a century, and frequent déjà vu is also now known to be associated with focal seizures, particularly those of a medial temporal lobe (MTL) origin. A longstanding question is whether seizure-related déjà vu has the same basis and is the same subjective experience as non-seizure déjà vu. Survey research suggests that people who experience both seizure-related and non-seizure déjà vu can often subjectively distinguish between the two. We present a case of a person with a history of focal MTL seizures who reports having experienced both seizure-related and non-seizure common déjà vu, though the non-seizure type was more frequent during this person's youth than it is currently. The patient was studied with a virtual tour paradigm that has previously been shown to elicit déjà vu among non-clinical, young adult participants. The patient reported experiencing déjà vu of the common non-seizure type during the virtual tour paradigm, without associated abnormalities of the intracranial EEG. We situate this work in the context of broader ongoing projects examining the subjective correlates of seizures. The importance for memory research of virtual scenes, spatial tasks, virtual reality (VR), and this paradigm for isolating familiarity in the context of recall failure are discussed.
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[Clinical, structural and functional features of paroxismal syndrome in insular and temporal lobe tumors] [Article in Russian]
Khachatryan, R. G.1, Bart, V. A.1,2, Maslova, L. N.1, Fadeeva, T. N.1, Sebelev, K. I.1, Tastanbekov, M. M.1, Alekseeva, T. M.1, Khachatryan, V. A.1
1 Almazov National Medical Research Center, St. Petersburg, Russia.
2 Saint-Petersburg State University, St. Petersburg, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 84(4):36-45, 2020.
PMID: 32759925 DOI: 10.17116/neiro20208404136
Abstract
Objective: To analyze the characteristics of paroxysmal syndrome in insular and temporal lobe tumors, to determine their relationship with the histological structure of tumor, to assess the effect of tumor growth nature on severity of disease.
Material and methods: A retrospective analysis enrolled 80 patients aged 11 - 80 years with insular and temporal lobe tumors and symptomatic epilepsy. All patients underwent surgery at the Polenov National Research Neurosurgery Center in Almazov National Medical Research Center for the period from 2012 to 2018.
Results: The main group consisted of 29 patients with tumors of temporal and insular lobes. Control group of 51 patients with temporal gliomas was formed for comparative analysis. It was found that involvement of insular lobe into paroxysmal syndrome is characterized by attacks with a motor component, somatosensory paroxysms, vegetative manifestations (respiratory attacks, salivation, nausea), speech disorders and taste hallucinations. Derealization, motor arrest and déjà vu/jamis vu paroxysms were more common in patients with temporal lobe lesion. Neoplastic lesion of the insular lobe shortens the period between manifestation of paroxysms and surgical treatment. Moreover, this type of disease is characterized by higher incidence of seizures compared to isolated temporal lobe tumors.
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Reliability of additional reported seizure manifestations to identify dissociative seizures
Kerr, W. T.1, Zhang, X.2, Janio,, E. A.3, Karimi, A. H.2,, Allas, C. H.2, Dubey, I.2, Sreenivasan,, S. S.2, Bauirjan, J.2, D'Ambrosio, S. R.2, Banna, M. A.2, Cho, A. Y.4, Engel Jr., J.5, Cohen, M. S.6, Feusner, J. D.3, Stern, J. M.2
1 Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA. Electronic address:
2 Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
3 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
4 Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
5 Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; Departments of Radiology, Psychology, Biomedical Physics, and Bioengineering, University of California Los Angeles, Los Angeles, CA, USA.
6 Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; California NanoSystems Institute, University of California Los Angeles, Los Angeles, CA, USA.
Epilepsy Behavior 31; 115:107696, 2020.
doi: 10.1016/j.yebeh.2020.107696. Online ahead of print.
PMID: 33388672
Abstract
Purpose: Descriptions of seizure manifestations (SM), or semiology, can help localize the symptomatogenic zone and subsequently included brain regions involved in epileptic seizures, as well as identify patients with dissociative seizures (DS). Patients and witnesses are not trained observers, so these descriptions may vary from expert review of seizure video recordings of seizures. To better understand how reported factors can help identify patients with DS or epileptic seizures (ES), we evaluated the associations between more than 30 SMs and diagnosis using standardized interviews.
Methods: Based on patient- and observer-reported data from 490 patients with diagnoses documented by video-electoencephalography, we compared the rate of each SM in five mutually exclusive groups: epileptic seizures (ES), DS, physiologic seizure-like events (PSLE), mixed DS and ES, and inconclusive testing.
Results: In addition to SMs that we described in a prior manuscript, the following were associated with DS: light triggers, emotional stress trigger, pre-ictal and post-ictal headache, post-ictal muscle soreness, and ictal sensory symptoms. The following were associated with ES: triggered by missing medication, aura of déjà vu, and leftward eye deviation. There were numerous manifestations separately associated with mixed ES and DS.
Conclusions: Reported SM can help identify patients with DS, but no manifestation is pathognomonic for either ES or DS. Patients with mixed ES and DS reported factors divergent from both ES-alone and DS-alone.
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Familial mesial temporal lobe epilepsy in Mexico: Inheritance pattern and clinical features
Guzmán-Jiménez, D. E.1, Campos, J.B.2, Venegas-Vega, C.A.3, Sánchez, M.A.4, Velasco, A.L.5
1 Epilepsy Clinic, General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico; Programa de Doctorado en Ciencias Biomédicas, División de Estudios de Posgrado, Universidad Nacional Autónoma de México (UNAM), Universidad 3000, 04510, Mexico City, Mexico. Electronic address:
2 Medical School, Universidad Nacional Autónoma de México, Mexico City, Mexico; Experimental Medicine Unit, Universidad Nacional Autónoma de México, in the General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico. Electronic address:
3 Medical School, Universidad Nacional Autónoma de México, Mexico City, Mexico; Genetic Unit, General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico. Electronic address:
4 Epilepsy Clinic, General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico. Electronic address:
5 Epilepsy Clinic, General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico. Electronic address:
Epilepsy Research 167:106450, 2020.
doi: 10.1016/j.eplepsyres.2020.106450. Online ahead of print.
PMID: 32949980
Abstract
Purpose: The objectives of this study were to determine the inheritance pattern by which familial mesial temporal lobe epilepsy (FMTLE) is segregated in Mexican families, and to identify if there was an association between the clinical characteristics and the inheritance pattern.
Method: We included a total of 25 families with two or more members affected with MTLE during two years and elaborated a family pedigree for each family. The inheritance pattern was classified as autosomal dominant (AD) or autosomal recessive (AR), considering the affected members. We used statistical analysis association and differences between clinical characteristics and inheritance patterns.
Results: The affected families with the AD pattern were 15.7 fold times more likely to start seizures at 5 years of age or earlier than families with AR pattern, OR = 15.7 (IC 95% = 1.9-128.9). We observed a predominance and greater déjà vu association (64.4% vs 31.3%; p = 0.021), OR = 3.9 (CI 95% = 1.1-13.5) in patients with AD versus AR pattern. Finally, we identified that patients with AD pattern had a likelihood of presenting emotional alterations 5.6 times higher than AR (OR = 5.6, IC = 1.1-27.5).
Conclusion: FMTLE is a heterogeneous syndrome, both phenotypically and genotypically; thus, our findings may be helpful for clinical use to perform an early diagnosis, to provide timely treatment, and to prevent comorbidities associated to this disease. However, in order to identify the possible genetic causes underlying these inheritance patterns, the use of molecular studies is necessary.
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Temporal Lobe Epilepsy: Is It in Your Differential Diagnosis? Two Case Reports.
Avery, D. K., Min, J. B. D.
Independent Practitioners, Colorado Springs, CO.
CNS Spectrum 25(2):282, 2020.
doi: 10.1017/S1092852920000462.
Abstract
TEMPORAL LOBE EPILEPSY:
Is it in your differential diagnosis? Two Case Reports.
OBJECTIVE:
Temporal Lobe Epilepsy (TLE), also referred as Complex Partial Seizures, is a medical diagnosis that must be considered in the pediatric, adolescent, and adult population presenting for psychiatric care. Mood disorders are common in people with epilepsy, with a prevalence rate of 20 to 50%. Scant literature exists that seeks specifically to enhance our knowledge of the similarities and subtle differences between TLE, Bipolar Disorder (BD) and Post Traumatic Stress Disorder (PTSD). Our objective is to describe an adolescent and adult case; one initially diagnosed as BD, the other PTSD, when in fact, it was TLE. We aim to illustrate that misdiagnosis and failure to diagnose are common. The provider must engage in a thorough review of systems and consider TLE in the differential diagnosis. A delay in the appropriate diagnosis and treatment can lead to a substantial amount of adverse effects and worsening of symptoms and negatively impact one's quality of life.
METHOD:
Two case studies; an adolescent and one adult, diagnosed with BD and the other PTSD. Both endorsed a history of symptoms indicative of TLE. Key assessment findings and screening diagnostics alerted us to the differential diagnosis of TLE. The overlap of the symptom presentation is described.
RESULTS:
TLE and many psychiatric conditions often present with overlapping symptoms. Patients have the potential to present with absence seizures, unprovoked irritability, oppositionality, aggression, anger, paroxysmal anxiety, somatic symptoms such as headaches, nausea, burning in the abdomen, stereotyped movements or behaviors, hypergraphia bizarre or incongruous affect, symptoms of fear, disturbed sleep, tearfulness, memory problems, déjà vu, fugue states, changes in cognition, inability to concentrate, fatigue, auditory and visual hallucination and bad temper.Our differential diagnosis of TLE was confirmed with electroencephalogram (EEG). By prescribing the appropriate medications to these two individuals, they were able to experience improved moods, become more productive in society, working, attending church, family outings, etc. They were weaned off their antipsychotic medications, of which an abundance of troubling side effects is now a non-issue.
CONCLUSIONS:
A delay in the proper diagnosis of TLE can have a significant negative impact on the adolescent and adult population. A need exists to educate mental health professionals on the overlap of symptoms of TLE and psychiatric disorders. The significant issue at hand is that they may not be receiving adequate or appropriate medications. Considering TLE in the differential diagnosis of presenting mood instability ensures our patients they are getting the basics of psychiatric care; which always emphasizes ruling out medical conditions first.
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Unusual diagnostic findings in temporal lobe epilepsy: A combined MRI and 18 F-dopa case study
Feraco, P.1,2, Donner, D.3, Picori, L.3, Rozzanigo, U.1
1 Neuroradiology Unit, S. Chiara Hospital, Trento, Italy.
2 University of Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), Italy.
3 Nuclear Medicine Unit, S. Chiara Hospital, Trento, Italy.
European Journal of Radiology Open 20(7):100241, 2020.
doi: 10.1016/j.ejro.2020.100241. PMID: 32695848 PMCID: PMC7365897 eCollection 2020.
Abstract
Temporal lobe epilepsy is the most common focal epilepsy in adults and often causes pharmacoresistant seizures. Magnetic resonance imaging (MRI) and PET studies have widely demonstrated a number of morphological and molecular abnormalities in epilepsy. However, considering the dopaminergic system, only a bilateral 18F-DOPA uptake reduction within the basal ganglia has been described. We report the unusual finding of increased 18F-DOPA uptake in a patient with focal recurrent seizures and "deja vu" experiences in the setting of cortical swelling detected at MRI exam. The final diagnosis was in in keeping with hippocampal sclerosis, confirmed during follow-up MR exams. In this case 18F-DOPA uptake may represent increased dopamine transport induced by seizures. Nuclear medicine physicians and radiologists should be aware of clinical and electroencephalographic findings when interpreting brain areas of tracer uptake, which are not always related to malignancy.
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Déjà vu and prescience in a case of severe episodic amnesia following bilateral hippocampal lesions
Memory 6:1-16, 2019.
doi: 10.1080/09658211.2019.1673426. [Epub ahead of print]
Curot J1,2,3, Pariente J1,4, Hupé JM2,3, Lotterie JA4,5, Mirabel H1, Barbeau EJ2,3.
1 Neurologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse , Toulouse , France.
2 Centre de Recherche Cerveau et Cognition, Université de Toulouse, Université Paul Sabatier Toulouse , Toulouse , France.
3 CerCo, UMR 5549, Centre National de la Recherche Scientifique, Toulouse Mind and Brain Institute , Toulouse , France.
4 INSERM, U1214, TONIC, Toulouse Mind and Brain Institute , Toulouse , France.
5 Radiochirurgie stéréotaxique, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse , Toulouse , France.
Abstract
Several studies pertaining to déjà vu have consistently made a connection with the perirhinal region, a region located below the hippocampus. This idea is strengthened by the fact that déjà vu is an erroneous sense of familiarity and that familiarity appears to largely depend on the perirhinal region in healthy subjects. In this context, the role of the hippocampus is particularly unclear as it is unknown whether or not it plays a role in the genesis of déjà vu. We report on the case of OHVR, an epileptic patient who suffers from severe episodic amnesia related to massive isolated bilateral damage to the hippocampus. In contrast, the perirhinal region is intact structurally and functionally. This patient reports frequent déjà vu but also another experiential phenomenon with a prominent feeling of prescience, which shows some of the characteristics of déjà vécu. She clearly distinguishes both. She also developed a form of synaesthesia by attributing affective valence to numbers. This study shows that déjà vu can occur in cases of amnesia with massively damaged hippocampi and confirms that the perirhinal region is a core region for déjà vu, using a different approach from previous reports. It also provides clues about a potential influence of hippocampal alterations in déjà vécu.
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Ictal asystole: a diagnostic and management conundrum
Mbizvo GK1,2, Derry C2,3, Davenport R2.
1 Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh Child Life and Health, 20 Sylvan Place, Edinburgh EH9 1UW, UK,
2 Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
3 Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK.
Journal of the Royal College of Physicians Edinb. 49(2):128-131, 2019.
doi: 10.4997/JRCPE.2019.209.
Abstract
We report two cases of adults presenting with transient loss of consciousness (TLoC) followed by a rapid recovery. Careful history taking revealed a stereotyped prodrome of déjà vu, raising the possibility of these events being focal seizures rather than syncope. The patients were commenced on antiepileptic drugs (AEDs) at the same time as having cardiac monitoring organised. This confirmed asystole during the seizure symptoms, resulting in TLoC. It was assumed that the cardiac arrhythmia explained the entire picture, a permanent pacemaker (PPM) was inserted, and the AEDs were withdrawn in one patient and not commenced in the other. However, they both subsequently presented with worsening seizures, including generalised tonic-clonic seizures, despite a functioning pacemaker. The seizures improved on restarting AEDs. The cases illustrate the diagnostic and management difficulties of patients presenting with ictal asystole, a condition that requires input from various medical specialities. There is no strong evidence base for the management of ictal asystole, but we favour a combined approach of AEDs and PPM insertion.
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Musicogenic epilepsy: A Stereo-electroencephalography study
Pelliccia V1, Villani F2, Gozzo F1, Gnatkovsky V2, Cardinale F1, Tassi L3.
1 C. Munari Epilepsy Surgery Centre, Ospedale Niguarda, Milano, Italy.
2 Epilepsy Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milano, Italy.
3 C. Munari Epilepsy Surgery Centre, Ospedale Niguarda, Milano, Italy. Electronic address:
Cortex 120:582-587, 2019. doi: 10.1016/j.cortex.2019.02.005. Epub 2019 Feb 13.
Abstract
Musicogenic epilepsy is rare focal epilepsy in which seizures are triggered by music. Both spontaneous and reflexes seizures may occur. To date there are limited data about this epilepsy, particularly about its etiopathogenesis. We report the clinical, neurophysiological and imaging data about musicogenic epilepsy in a patient who underwent Stereo-electroencephalography (SEEG) study. A 27 year-old right-handed woman suffering from drug-resistant epilepsy since the age of 17 years, was evaluated for surgery. She had weekly seizures characterized by an unpleasant ascending gastric sensation, tachycardia, occasionally late oro-alimentary automatisms, déjà-vu and vomiting. Only during longer seizures a partial loss of awareness was reported. Interestingly, familiar songs triggered seizures. Rarely, she had spontaneous seizures with the same features. The ictal EEG onset appeared to be right temporal, but there was seizure propagation to suprasylvian areas. Brain MRI was negative. A SEEG implantation was performed to study the right temporo-perisylvian regions. SEEG data clearly indicated the antero-mesial temporal regions as origin of the seizures, without any spread to other close or distant cortical areas. Right temporal antero-mesial resection was performed 24 months ago and the patient is seizure-free since surgery. Neuropathology was uninformative. SEEG data highlighted the hypothesis regarding a temporo-mesial emotional-mnesic network triggered by particular music with an affective component for the patient. The primary auditory cortex and lateral mid-posterior temporal and extratemporal cortices were not involved. Different triggers as mentally singing and hearing the music can induce seizure as well as electrical stimulation in the mesial temporal structures.
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Functional activity changes in memory and emotional systems of healthy subjects with déjà vu
Nigro S1, Cavalli SM2, Cerasa A3, Riccelli R4, Fortunato F2, Bianco MG5, Martino I2, Chiriaco C3, Vaccaro MG2, Quattrone A6, Gambardella A7, Labate A8.
1 Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.
2 Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy.
3 Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.
4 Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.
5 Department of Health Sciences, Magna Graecia University, Catanzaro, Italy.
6 Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy; Neuroscience Centre, Magna Graecia University, Catanzaro, Italy.
7 Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy. Electronic address:
8 Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy. Electronic address:
Epilepsy Behavior 97:8-14, 2019. doi: 10.1016/j.yebeh.2019.05.018. Epub 2019 Jun 7.
Abstract
Déjà vu (DV) is a fascinating and mysterious human experience that has attracted interest from psychologists and neuroscientists for over a century. In recent years, several studies have been conducted to unravel the psychological and neurological correlates of this phenomenon. However, the neural mechanisms underlying the DV experience in benign manifestations are still poorly understood. Thirty-three healthy volunteers completed an extensive neuropsychiatric and neuropsychological battery including personality evaluation. The presence of DV was assessed with the Inventory for Deja vu Experiences Assessment. Participants underwent episodic memory learning test, and 2 days later during event-related functional magnetic resonance imaging (fMRI), they are asked to rate old and new pictures as a novel, moderately/very familiar, or recollected. We identified 18 subjects with DV (DV+) and 15 without DV (DV-) matched for demographical, neuropsychological, and personality characteristics. At a behavioral level, no significant difference was detected in the episodic memory tasks between DV+ and DV-. Functional magnetic resonance imaging analysis revealed that DV+, independently from task conditions, were characterized by increased activity of the bilateral insula coupled with reduced activation in the right parahippocampal, both hippocampi, superior/middle temporal gyri, thalami, caudate nuclei, and superior frontal gyri with respect to DV-. Our study demonstrates that individuals who experienced DV are not characterized by different performance underlying familiarity/recollection memory processes. However, fMRI results provide evidence that the physiological DV experience is associated with the employment of different neural responses of brain regions involved in memory and emotional processes.
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Déjà-rêvé: Prior dreams induced by direct electrical brain stimulation
Curot J1, Valton L2, Denuelle M3, Vignal JP4, Maillard L5, Pariente J6, Trébuchon A7, Bartolomei F7, Barbeau EJ8.
1 Toulouse University Hospital, Department of Neurology, Toulouse, FR 31059, France; Centre de Recherche Cerveau et Cognition, CNRS, UMR5549, FR 31052, France. Electronic address:
2 Toulouse University Hospital, Department of Neurology, Toulouse, FR 31059, France; Centre de Recherche Cerveau et Cognition, CNRS, UMR5549, FR 31052, France.
3 Toulouse University Hospital, Department of Neurology, Toulouse, FR 31059, France.
4 Nancy University & CNRS, CRAN, UMR 7039, FR 54516, France.
5 Nancy University & CNRS, CRAN, UMR 7039, FR 54516, France; University Hospital of Nancy, Neurology Department Nancy, FR 54035, France.
6 Toulouse University Hospital, Department of Neurology, Toulouse, FR 31059, France; INSERM, U1214, TONIC, Toulouse Mind and Brain Institute, FR 31024, France.
7 Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, FR 13005, France; AP-HM, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, FR 13005, France.
8 Centre de Recherche Cerveau et Cognition, CNRS, UMR5549, FR 31052, France.
Brain Stimulation 11(4):875-885, 2018. doi: 10.1016/j.brs.2018.02.016. Epub 2018 Feb 24.
Abstract
BACKGROUND:
Epileptic patients sometimes report experiential phenomena related to a previous dream they had during seizures or electrical brain stimulation (EBS). This has been alluded to in the literature as "déjà-rêvé" ("already dreamed"). However, there is no neuroscientific evidence to support its existence and this concept is commonly mixed up with déjà-vu. We hypothesized that déjà-rêvé would be a specific entity, i.e., different from other experiential phenomena reported in epileptic patients, induced by EBS of specific brain areas.
METHODS:
We collected all experiential phenomena related to dreams induced by electrical brain stimulations (EBS) in our epileptic patients (2003-2015) and in a review of the literature. The content of these déjà-rêvé and the location of EBS were analyzed.
RESULTS:
We collected 7 déjà-rêvé in our database and 35 from the literature, which corresponds to an estimated prevalence of 0.3‰ of all EBS-inducing déjà-rêvé. Déjà-rêvé is a generic term for three distinct entities: it can be the recollection of a specific dream ("episodic-like"), reminiscence of a vague dream ("familiarity-like") or experiences in which the subject feels like they are dreaming (literally "a dreamy state"). EBS-inducing "episodic-like" and "familiarity-like" déjà-rêvé were mostly located in the medial temporal lobes. "Dreamy states" were induced by less specific EBS areas although still related to the temporal lobes.
CONCLUSIONS:
This study demonstrates that déjà-rêvé is a heterogeneous entity that is different from déjà-vu, the historical "dreamy state" definition and other experiential phenomena. This may be relevant for clinical practice as it points to temporal lobe dysfunction and could be valuable for studying the neural substrates of dreams.
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[A case series of 4 epilepsy patients with promnesia] [Article in Japanese]
Kajikawa S1, Kobayashi K1, Usami K2, Matsumoto R1, Ikeda A3, Takahashi R1.
1 Department of Neurology, Kyoto University Graduate School of Medicine.
2 Department of Neurology, Otsu Red Cross Hospital.
3 Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine.
Rinsho Shinkeigaku 58(8):513-516, 2018. doi: 10.5692/clinicalneurol.cn-001149. Epub 2018 Jul 31.
Abstract
Promnesia is a feeling of familiarity and foreknowledge and is a manifestation of simple partial seizures (focal aware seizures). It is similar to déjà vu and has been reported to be a rare symptom in patients with temporal lobe epilepsy. Here, we investigated the clinical characteristics in 4 patients with partial epilepsy presenting promnesia. Three out of 4 patients showed abnormal electroencephalography (EEG) and/or MRI findings in the temporal lobe. Furthermore, in 2 patients, promnesia was the only aura. It is important to actively obtain medical history of patients about promnesia because this is useful for identifying the epileptic focus. Further cases need to be analyzed to evaluate the sensitivity and specificity of promnesia for diagnosis and therapy of partial epilepsy.
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Insight into epileptic and physiological déjà vu: from a multicentric cohort study
Labate A1, Baggetta R2, Trimboli M1, Tripepi G2, Bisulli F3, D'Aniello A4, Daniele O5, Di Bonaventura C6, Di Gennaro G4, Fattouch J6, Ferlazzo E1,7, Ferrari A8, Gasparini S1,7, Giallonardo A6, La Neve A9, Romigi A4, Sofia V10, Tinuper P3, Zummo L5, Aguglia U1,7, Gambardella A1.
1 Institute of Neurology, University Magna Graecia, Catanzaro, Italy.
2 Institute of Clinical Physiology, Research Unit, National Research Council (IFC-CNR), Reggio Calabria, Italy.
3 IRCCS Institute of Neurological Science of Bologna and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
4 IRCSS Neuromed, Pozzilli, Italy.
5 Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy.
6 Department of Neuroscience, Neurology Unit, 'Sapienza' University, Rome, Italy.
7 Regional Epilepsy Center, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy.
8 Clinical Neurophysiology, Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genova, Italy.
9 Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy.
10 Department 'G. F. Ingrassia' University of Catania, Catania, Italy.
European Journal of Neurology Sep 5 2018. doi: 10.1111/ene.13806. [Epub ahead of print]
Abstract
BACKGROUND AND PURPOSE:
The presence of a continuum between physiological déjà vu (DV) and epileptic DV is still not known as well as epidemiological data in the Italian population. The aim was to identify the epidemiological distribution of DV in Italy, and secondly to look for specific features of DV able to discriminate between epileptic and non-epileptic DV.
METHODS:
In all, 1000 individuals, 543 healthy controls (C) (313 women; age 40 ± 15 years) and 457 patients with epilepsy (E) (260 women; age 39 ± 14 years), were prospectively recruited from 10 outpatient neurological clinics throughout Italy. All populations were screened using the Italian Inventory for Déjà Vu Experiences Assessment (I-IDEA) test and E and pairwise C underwent a comprehensive epilepsy interview.
RESULTS:
Of E, 69% stated that they experienced 'recognition' and 13.2% reported that this feeling occurred from a few times a month to at least weekly (versus 7.7% of the control group). Furthermore, a greater percentage of E (6.8% vs. 2.2%) reported that from a few times a month to at least weekly they felt that it seemed as though everything around was not real. In E, the feeling of recognition raised fright (22.3% vs. 13.2%) and a sense of oppression (19.4% vs. 9.4%). A fifth of E felt recognition during epileptic seizures.
CONCLUSION:
Only E regardless of aetiology firmly answered that they had the feeling of recognition during an epileptic seizure; thus question 14 of the I-IDEA test part 2 discriminated E from C. Paranormal activity, remembering dreams and travel frequency were mostly correlated to DV in E suggesting that the visual-memory network might be involved in epileptic DV.
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Automnomic Seizures and Déjà Vu in a Patient with Gangliocytoma of the Orbitofrontal Cortex
Psychiatria Danubina 30(2): 220-222, 2018. https://doi.org/10.24869/psyd.2018.220
Helena Šarac1, Željka Petelin Gadže2, Goran Pavliša3, Sanja Perić4, Marija Bošnjak Pašić5, Hanna Pašić6 & Neven Henigsberg7
1 Center of Excellence for Basic and Translational Neuroscience, Medical School University of Zagreb, Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia
2 Department of Neurology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Referral Centre for Epilepsy, Ministry of Health of the Republic of Croatia, Zagreb, Croatia
3 Clinical Institute of Radiology, University Hospital Center Zagreb, Zagreb, Croatia
4 Department of Ophtalmology, University Hospital Center Zagreb, Zagreb, Croatia
5 Medical School University of Osijek, University Hospital Center Zagreb, Department of Neurology, Zagreb, Croatia
6 Medical School University of Zagreb, Zagreb, Croatia
7 Medical School University of Zagreb, Croatian Institute for Brain Research, Zagreb, Croatia
CONCLUSION
We presented a case of one lesional orbitofrontal epilepsy in whom the disappearance of autonomic seizures after surgical resection limited to the orbitofrontal cortex confirmed the anatomic site of the epileptic focus. Our study also identified probably nonpathological déjà vu phenomenon which is not characteristic of patients with epilepsy and it may be basically a psychological phenomenon.
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Abnormal rsFC and GMV changes in parahippocampal and DLPFC for high Déjà vu experienced subjects
Qiu J1, Xia Y2, He L3, Chen Q2, Sang N2, Liu W4, Li H5.
1 College of Education Science, ChengDu University, ChengDu, 610106, China; School of Psychology, Southwest University, Chongqing, 400715, China. Electronic address:
2 School of Psychology, Southwest University, Chongqing, 400715, China.
3 School of Education, Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, 401331, China.
4 Donders Institute for Brain, Cognition and Behavior Centre for Cognitive Neuroimaging (DCCN) Radboud University, Netherlands.
5 College of Psychology and Sociology, Shenzhen University, Shenzhen, 518060, China. Electronic address:
Biol Psychol. 133:72-78, 2018 doi: 10.1016/j.biopsycho.2018.02.001. Epub 2018 Feb 6.
Abstract
How déjà vu works has long been a mystery, partially because of its characteristics of unpredictable occurrences and quick disappearances, which make it difficult to be explored. Previous studies have described the anatomical structures underlying déjà vu in healthy subjects; however, the functional mechanism of déjà vu remains unclear. Therefore, this study investigated the brain structural and functional components underlying déjà vu by combining voxel-based morphometry analysis (VBM) with resting-state functional connectivity (rsFC). The VBM analysis revealed that the anterior parahippocampal gyrus (PHG) had significantly less grey matter volume (GMV) in high déjà vu group than low group, confirming previous studies. Further functional connectivity analysis revealed that the frequency of déjà vu experiences was negatively correlated with the strength of the rsFC between anterior dorsal lateral prefrontal cortex (DLPFC) and anterior PHG but positively correlated with the strength of the rsFC between posterior DLPFC and posterior PHG. Moreover, the frequency of déjà vu experiences was negatively correlated with the strength of the rsFC between the anterior and posterior regions of the PHG. These findings indicated that familiarity without recollection (PHG) and superior context monitoring (DLPFC) are critical for real-life déjà vu experiences.
PMID: 29426017 DOI: 10.1016/j.biopsycho.2018.02.001
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Many Faces of Déjà Vu: a Narrative Review
Bošnjak Pašić M, Horvat Velić E, Fotak L, Pašić H, Srkalović Imširagić A, Milat D, Šarac H, Bjedov S, Petelin GadŽe Ž.
University Hospital Centre Zagreb, Department of Neurology, Kišpatićeva 12, 10000 Zagreb, Croatia.
Psychiatr Danub. 30(1):21-25, 2018 doi: 10.24869/psyd.2018.21.
Abstract
French expression standing for the phrase "already seen" is a déjà vu. It is thought that as much as 97% of the population have experienced déjà vu at least once in their lifetime and 67% experience it regularly. The explanations of this phenomenon in novels and poems include reincarnation, dreams, organic factors, and unconscious memories. In this narrative review connection between déjà vu and various other conditions has been mentioned: false memories, temporal lobe epilepsy and other neurological conditions. In psychiatric patients déjà vu phenomenon is more often seen in patients with anxiety and people with derealisation/ depersonalization. It seems that temporal region is the origin of déjà vu phenomena in both healthy individuals and in individuals with neurological and psychiatric conditions, but the exact mechanism of this phenomenon is however still unknown. More attention should also be given to déjà vu from philosophical and religious perspectives as well. Déjà vu is still an enigma which could only be revealed with multidisciplinary approach through cooperation between neurologists, brain scientists, psychiatrists and experimental psychologists.
PMID: 29546854 DOI: 10.24869/psyd.2018.21
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The clinical phenotype of autosomal dominant lateral temporal lobe epilepsy related to reelin mutations
Michelucci R1, Pulitano P2, Di Bonaventura C3, Binelli S4, Luisi C5, Pasini E6, Striano S7, Striano P8, Coppola G9, La Neve A5, Giallonardo AT3, Mecarelli O2, Serioli E10, Dazzo E10, Fanciulli M11, Nobile C10.
1 IRCCS - Institute of Neurological Sciences of Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy.
2 Department of Neurology and Psychiatry, University of Rome "Sapienza", Policlinico Umberto 1° Hospital, Roma, Italy.
3 Department of Neurological Sciences, University of Rome "Sapienza," Roma, Italy.
4 C. Besta Foundation Neurological Institute, Milano, Italy.
5 Neurology Clinic, University of Bari, Bari, Italy.
6 IRCCS - Institute of Neurological Sciences of Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy. Electronic address:
7 Department of Neurological Sciences, Federico II University, Napoli, Italy.
8 Muscular and Neurodegenerative Disease Unit, Institute "G. Gaslini," University of Genova, Italy.
9 Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Italy.
10 Section of Padua, Institute of Neurosciences, Consiglio Nazionale delle Ricerche, Padova, Italy.
11 Porto Conte Ricerche, Alghero, Italy.
Epilepsy Behav. 68:103-107, 2017 doi: 10.1016/j.yebeh.2016.12.003. Epub 2017 Jan 28.
Abstract
OBJECTIVE:
To describe the clinical phenotype of 7 families with Autosomal Dominant Lateral Temporal Lobe Epilepsy (ADLTE) related to Reelin (RELN) mutations comparing the data with those observed in 12 LGI1-mutated pedigrees belonging to our series.
METHODS:
Out of 40 Italian families with ADLTE, collected by epileptologists participating in a collaborative study of the Commission for Genetics of the Italian League against Epilepsy encompassing a 14-year period (2000-2014), 7 (17.5%) were found to harbor heterozygous RELN mutations. The whole series also included 12 (30%) LGI1 mutated families and 21 (52.5%) non-mutated pedigrees. The clinical, neurophysiological, and neuroradiological findings of RELN and LGI1 mutated families were analyzed.
RESULTS:
Out of 28 affected individuals belonging to 7 RELN mutated families, 24 had sufficient clinical data available for the study. In these patients, the epilepsy onset occurred at a mean age of 20years, with focal seizures characterized by auditory auras in about 71% of the cases, associated in one-third of patients with aphasia, visual disturbances or other less common symptoms (vertigo or déjà-vu). Tonic-clonic seizures were reported by almost all patients (88%), preceded by typical aura in 67% of cases. Seizures were precipitated by environmental noises in 8% of patients and were completely or almost completely controlled by antiepileptic treatment in the vast majority of cases (96%). The interictal EEG recordings showed epileptiform abnormalities or focal slow waves in 80% of patients, localized over the temporal regions, with marked left predominance and conventional 1,5T MRI scans were not contributory. By comparing these findings with those observed in families with LGI1 mutations, we did not observe significant differences except for a higher rate of left-sided EEG abnormalities in the RELN group.
SIGNIFICANCE:
Heterozygous RELN mutations cause a typical ADLTE syndrome, indistinguishable from that associated with LGI1 mutations.
Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
PMID: 28142128 PMCID: PMC5378904 DOI: 10.1016/j.yebeh.2016.12.003
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Familial mesial temporal lobe epilepsy and the borderland of déjà vu
Perucca P1,2, Crompton DE2,3, Bellows ST2, McIntosh AM1,2, Kalincik T1, Newton MR2, Vajda FJE1, Scheffer IE2,4,5, Kwan P1, O'Brien TJ1, Tan KM1, Berkovic SF2.
1 Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
2 Epilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
3 Neurology Department, Northern Health, Melbourne, Victoria, Australia.
4 Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
5 Departments of Paediatrics and Neurology, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Annals of Neurology 82(2):166-176, 2017. doi: 10.1002/ana.24984. Epub 2017 Jul 19.
Abstract
OBJECTIVE:
The cause of mesial temporal lobe epilepsy (MTLE) is often unknown. We ascertained to what extent newly diagnosed nonlesional MTLE actually represents familial MTLE (FMTLE).
METHODS:
We identified all consecutive patients presenting to the Austin Health First Seizure Clinic with MTLE and normal magnetic resonance imaging (MRI) or MRI evidence of hippocampal sclerosis over a 10-year period. Patients' first-degree relatives and pairwise age- and sex-matched controls underwent a comprehensive epilepsy interview. Each interview transcript was reviewed independently by 2 epileptologists, blinded to relative or control status. Reviewers classified each subject as follows: epilepsy, specifying if MTLE; manifestations suspicious for epilepsy; or unaffected. Physiological déjà vu was noted.
RESULTS:
Forty-four patients were included. At the Clinic, MTLE had been recognized to be familial in 2 patients only. Among 242 subjects interviewed, MTLE was diagnosed in 9 of 121 relatives versus 0 of 121 controls (p = 0.008). All affected relatives had seizures with intense déjà vu and accompanying features; 6 relatives had not been previously diagnosed. Déjà vu experiences that were suspicious, but not diagnostic, of MTLE occurred in 6 additional relatives versus none of the controls (p = 0.04). Physiological déjà vu was common, and did not differ significantly between relatives and controls. After completing the relatives' interviews, FMTLE was diagnosed in 8 of 44 patients (18.2%).
INTERPRETATION:
FMTLE accounts for almost one-fifth of newly diagnosed nonlesional MTLE, and it is largely unrecognized without direct questioning of relatives. Relatives of patients with MTLE may experience déjà vu phenomena that clinically lie in the "borderland" between epileptic seizures and physiological déjà vu. Ann Neurol 2017;82:166-176.
© 2017 American Neurological Association.
PMID: 28681459 DOI: 10.1002/ana.24984
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Ictal fear: Associations with age, gender, and other experiential phenomena
Chong DJ1, Dugan P2; EPGP Investigators.
1 Department of Neurology, New York University Medical Center, 223 E 34th St., New York, NY 10011, USA. Electronic address:
2 Department of Neurology, New York University Medical Center, 223 E 34th St., New York, NY 10011, USA. Electronic address:
Epilepsy & Behavior 62: 153-8, 2016
Epub 2016 Jul 30 doi: 10.1016/j.yebeh.2016.05.017.
Abstract
PURPOSE:
The aim of this study was to determine the relationship of fear to other auras and to gender and age using a large database.
METHODS:
The Epilepsy Phenome/Genome Project (EPGP) is a multicenter, multicontinental cross-sectional study in which ictal symptomatology and other data were ascertained in a standardized series of questionnaires then corroborated by epilepsy specialists. Auras were classified into subgroups of symptoms, with ictal fear, panic, or anxiety as a single category.
RESULTS:
Of 536 participants with focal epilepsy, 72 were coded as having ictal fear/panic/anxiety. Reviewing raw patient responses, 12 participants were deemed not to have fear, and 24 had inadequate data, leaving 36 (7%) of 512 with definite ictal fear. In univariate analyses, fear was significantly associated with auras historically considered temporal lobe in origin, including cephalic, olfactory, and visceral complaints; déjà vu; and derealization. On both univariate and multivariate stepwise analyses, fear was associated with jamais vu and auras with cardiac symptoms, dyspnea, and chest tightening. Expressive aphasia was associated with fear on univariate analysis only, but the general category of aphasias was associated with fear only in the multivariate model. There was no age or gender relationship with fear when compared to the overall population with focal epilepsy that was studied under the EPGP. Patients with ictal fear were more likely to have a right hemisphere seizure focus.
CONCLUSIONS:
Ictal fear was strongly associated with other auras considered to originate from the limbic system. No relationship of fear with age or gender was observed.
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Lateralising value of experiential hallucinations in temporal lobe epilepsy
Lukas Heydrich1,2, Guillaume Marillier1, Nathan Evans1, Olaf Blanke1,2,3, Margitta Seeck2
1 Laboratory of Cognitive Neuroscience, Brain-Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland
2 Department of Neurology, University Hospital Geneva, Geneva, Switzerland
3 Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Switzerland
Correspondence to Dr Lukas Heydrich, Department of Neurology, Inselspital Bern, Freiburgstrasse 4, Bern 3010, Switzerland;
Journal of Neurology, Neurosurgery & Psychiatry 86(11): 1273-6, 2015
doi: 10.1136/jnnp-2014-309452. Epub 2015 Jan 13.
Abstract
Objectives
Ever since John Hughlings Jackson first described the so-called ‘dreamy state’ during temporal lobe epilepsy, that is, the sense of an abnormal familiarity (déjà vu) or vivid memory-like hallucinations from the past (experiential hallucinations), these phenomena have been studied and repeatedly linked to mesial temporal lobe structures. However, little is known about the lateralising value of either déjà vu or experiential hallucinations.
Methods
We analysed a sample of 28 patients with intractable focal epilepsy suffering from either déjà vu or experiential hallucinations. All the patients underwent thorough presurgical examination, including MRI, positron emission tomography, single-photon emission CT, EEG and neuropsychological examination.
Results
While déjà vu was due to right or left mesial temporal lobe epilepsy, experiential hallucinations were strongly lateralised to the left mesial temporal lobe. Moreover, there was a significant effect for interictal language deficits being more frequent in patients suffering from experiential hallucinations.
Conclusions
These results suggest a lateralising value for experiential hallucinations to the left temporal lobe.
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DEPDC5 mutations are not a frequent cause of familial temporal lobe epilepsy
Striano P1, Serioli E2, Santulli L3, Manna I4, Labate A4,5, Dazzo E2, Pasini E6, Gambardella A4,5, Michelucci R6, Striano S3, Nobile C2,7.
1 Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, G. Gaslini Institute, University of Genoa, Genova, Italy.
2 CNR-Neuroscience Institute, Section of Padua, Padova, Italy.
3 Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, Federico II University, Napoli, Italy.
4 Institute of Molecular Bioimaging and Physiology, Section of Germaneto, National Research Council, Catanzaro, Italy.
5 Institute of Neurology, University Magna Graecia, Catanzaro, Italy.
6 IRCCS-Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy.
7 Department of Biomedical Sciences, University of Padua, Padova, Italy.
Epilepsia 56(10): e168-71, 2015.
Epub 2015 Jul 27. doi: 10.1111/epi.13094. PMID: 26216793
Abstract
Mutations in the DEPDC5 (DEP domain-containing protein 5) gene are a major cause of familial focal epilepsy with variable foci (FFEVF) and are predicted to account for 12-37% of families with inherited focal epilepsies. To assess the clinical impact of DEPDC5 mutations in familial temporal lobe epilepsy, we screened a collection of Italian families with either autosomal dominant lateral temporal epilepsy (ADLTE) or familial mesial temporal lobe epilepsy (FMTLE). The probands of 28 families classified as ADLTE and 17 families as FMTLE were screened for DEPDC5 mutations by whole exome or targeted massive parallel sequencing. Putative mutations were validated by Sanger sequencing. We identified a DEPDC5 nonsense mutation (c.918C>G; p.Tyr306*) in a family with two affected members, clinically classified as FMTLE. The proband had temporal lobe seizures with prominent psychic symptoms (déjà vu, derealization, and forced thoughts); her mother had temporal lobe seizures, mainly featuring visceral epigastric auras and anxiety. In total, we found a single DEPDC5 mutation in one of (2.2%) 45 families with genetic temporal lobe epilepsy, a proportion much lower than that reported in other inherited focal epilepsies.
© 2015 The Authors. Epilepsia published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy.
Comment in
DEPDC5 mutations in epilepsy with auditory features. [Epilepsia. 2016]
In response: DEPDC5 mutations in epilepsy with auditory features. [Epilepsia. 2016]
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Neuro-anatomical differences among epileptic and non-epileptic déjà-vu
Labate A1, Cerasa A2, Mumoli L3, Ferlazzo E3, Aguglia U3, Quattrone A4, Gambardella A5.
1 Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, CZ, Italy. Electronic address:
2 Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, CZ, Italy.
3 Institute of Neurology, University Magna Græcia, Catanzaro, Italy.
4 Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, CZ, Italy.
5 Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, CZ, Italy. Electronic address:
Cortex 64: 1-7, 2015.
Epub 2014 Oct 7. doi: 10.1016/j.cortex.2014.09.020. PMID: 25461702
Abstract
OBJECTIVE:
Dèjà-vù (DV) can occur as a seizure of mesial temporal lobe epilepsy (MTLE) and in almost 80% of healthy individuals. The remarkable similarity between epileptic DV and DV in healthy individuals raises the possibility that DV might sometimes be an ictal phenomenon in apparently normal individuals. Thus, we studied a group of healthy subjects versus individuals with benign MTLE (bMTLE) both experiencing DV.
METHODS:
63 individuals with epilepsy patients with bMTLE and 39 healthy controls at Catanzaro University were recruited. Participants completed the Inventory for Déjà Vu (DV) Experiences Assessment (IDEA) test, underwent awake and asleep electroencephalogram, MRI of the brain using a 3T scanner and whole brain voxel-based morphometry (VBM). bMTLE patients with DVand without DV were also matched for the presence of hippocampal sclerosis.
RESULTS:
Our controls had no history of neurological or psychiatric illness, epilepsy or history of febrile convulsions. Neurological and cognitive examinations were normal. Electroencephalographic procedures were unremarkable in all controls. In bMTLE group, the direct comparison of VBM between individuals with epilepsy with DV versus those without DV revealed abnormal anatomical changes in the left hippocampus, parahippocampal gyrus and visual cortex. The VBM of healthy controls with DV showed abnormal anatomical changes only in the left insular cortex.
CONCLUSIONS:
Our VBM results demonstrated different morphologic patterns in individuals with epilepsy and control subjects experiencing DV, involving the memory circuit in bMTLE patients and cerebral regions in the emotional network in healthy controls.
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Structural covariance mapping delineates medial and medio-lateral temporal networks in déjà vu
Shaw DJ1, Mareček R2,3, Brázdil M2,3.
1 Behavioral and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.
2 Behavioral and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.
3 First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's Faculty Hospital, Brno, Czech Republic.
Brain Imaging and Behavior 10(4): 1016-1079, 2015.
[Epub ahead of print] PMID: 26520830 DOI: 10.1007/s11682-015-9471-8
Abstract
Déjà vu (DV) is an eerie phenomenon experienced frequently as an aura of temporal lobe epilepsy, but also reported commonly by healthy individuals. The former pathological manifestation appears to result from aberrant neural activity among brain structures within the medial temporal lobes. Recent studies also implicate medial temporal brain structures in the non-pathological experience of DV, but as one element of a diffuse neuroanatomical correlate; it remains to be seen if neural activity among the medial temporal lobes also underlies this benign manifestation. The present study set out to investigate this. Due to its unpredictable and infrequent occurrence, however, non-pathological DV does not lend itself easily to functional neuroimaging. Instead, we draw on research showing that brain structure covaries among regions that interact frequently as nodes of functional networks. Specifically, we assessed whether grey-matter covariance among structures implicated in non-pathological DV differs according to the frequency with which the phenomenon is experienced. This revealed two diverging patterns of structural covariation: Among the first, comprised primarily of medial temporal structures and the caudate, grey-matter volume becomes more positively correlated with higher frequency of DV experience. The second pattern encompasses medial and lateral temporal structures, among which greater DV frequency is associated with more negatively correlated grey matter. Using a meta-analytic method of co-activation mapping, we demonstrate a higher probability of functional interactions among brain structures constituting the former pattern, particularly during memory-related processes. Our findings suggest that altered neural signalling within memory-related medial temporal brain structures underlies both pathological and non-pathological DV.
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A case of focal epilepsy manifesting multiple psychiatric auras [Article in Japanese]
Ezura M1, Kakisaka Y, Jin K, Kato K, Iwasaki M, Fujikawa M, Aoki M, Nakasato N.
1 Department of Epileptology, Tohoku University Graduate School of Medicine
Brain and Nerve 67(1): 105-9, 2015
doi: 10.11477/mf.1416200093. PMID: 25585440
Abstract
We present a case of epilepsy with multiple types of focal seizures that were misdiagnosed as psychiatric disorders. A 20-year-old female patient presented with a variety of episodes, including loss of consciousness, deja vu, fear, delusion of possession, violent movements, and generalized convulsions. Each of these symptoms appeared in a stereotypic manner. She was initially diagnosed with a psychiatric disorder and treated with psychoactive medications, which had no effect. Long-term video electroencephalography revealed that her episodes of violent movement with impaired consciousness and secondarily generalized seizure were epileptic events originating in the right hemisphere. High-field brain magnetic resonance imaging for detecting subtle lesions revealed bilateral lesions from periventricular nodular heterotopia. Her final diagnosis was right hemispheric focal epilepsy. Carbamazepine administration was started, which successfully controlled all seizures. The present case demonstrates the pitfall of diagnosing focal epilepsy when it presents with multiple types of psychiatric aura. Epilepsy should thus be included in differential diagnoses, considering the stereotypic nature of symptoms, to avoid misdiagnosis.
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Sex differences in seizure types and symptoms
Carlson C1, Dugan P2, Kirsch HE3, Friedman D2; EPGP Investigators.
1 Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address:
2 Department of Neurology, New York University School of Medicine, New York, NY, USA.
3 Department of Neurology and Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
Epilepsy & Behavior 41: 103-8, 2014
doi: 10.1016/j.yebeh.2014.09.051. Epub 2014 Oct 14.
PMID: 25461198 PMCID: PMC4267158 DOI: 10.1016/j.yebeh.2014.09.051
Abstract
BACKGROUND:
Despite the increasing interest in sex differences in disease manifestations and responses to treatment, very few data are available on sex differences in seizure types and semiology. The Epilepsy Phenome/Genome Project (EPGP) is a large-scale, multi-institutional, collaborative study that aims to create a comprehensive repository of detailed clinical information and DNA samples from a large cohort of people with epilepsy. We used this well-characterized cohort to explore differences in seizure types as well as focal seizure symptoms between males and females.
METHODS:
We reviewed the EPGP database and identified individuals with generalized epilepsy of unknown etiology (GE) (n = 760; female: 446, male: 314), nonacquired focal epilepsy (NAFE) (n = 476; female: 245, male: 231), or both (n = 64; female: 33, male: 31). Demographic data along with characterization of seizure type and focal seizure semiologies were examined.
RESULTS:
In GE, males reported atonic seizures more frequently than females (6.5% vs. 1.7%; p < 0.001). No differences were observed in other generalized seizure types. In NAFE, no sex differences were seen for seizure types with or without alteration of consciousness or progression to secondary generalization. Autonomic (16.4% vs. 26.6%; p = 0.005), psychic (26.7% vs. 40.3%; p = 0.001), and visual (10.3% vs. 19.9%; p = 0.002) symptoms were more frequently reported in females than males. Specifically, of psychic symptoms, more females than males endorsed déjà vu (p = 0.001) but not forced thoughts, derealization/depersonalization, jamais vu, or fear. With corrections for multiple comparisons, there were no significant differences in aphasic, motor, somatosensory, gustatory, olfactory, auditory, vertiginous, or ictal headache symptoms between sexes.
CONCLUSIONS:
Significant differences between the sexes were observed in the reporting of atonic seizures, which were more common in males with GE, and for autonomic, visual, and psychic symptoms associated with NAFE, which were more common in females.
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Emergence of semiology in epileptic seizures
Chauvel P1, McGonigal A2
1 Institut de Neurosciences des Systèmes, INSERM UMR 1106, Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France; Service de Neurophysiologie Clinique, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France. Electronic address: patrick.chauvel a univ-amu.fr.
2 Institut de Neurosciences des Systèmes, INSERM UMR 1106, Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France; Service de Neurophysiologie Clinique, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France.
Epilepsy & Behavior 38: 94-103, 2014
pii: S1525-5050(13)00633-1. doi: 10.1016/j.yebeh.2013.12.003. [Epub ahead of print]
Abstract
Semiology, the manifestation of epilepsy, is dependent upon electrical activity produced by epileptic seizures that are organized within existing neural pathways. Clinical signs evolve as the epileptic discharge spreads in both time and space. Studying the relation between these, of which the temporal component is at least as important as the spatial one, is possible using anatomo-electro-clinical correlations of stereoelectroencephalography (SEEG) data. The period of semiology production occurs with variable time lag after seizure onset and signs then emerge more or less rapidly depending on seizure type (temporal seizures generally propagating more slowly and frontal seizures more quickly). The subset of structures involved in semiological production, the "early spread network", is tightly linked to those constituting the epileptogenic zone. The level of complexity of semiological features varies according to the degree of involvement of the primary or associative cortex, with the former having a direct relation to peripheral sensory and motor systems with production of hallucinations (visual and auditory) or elementary sensorimotor signs. Depending on propagation pattern, these signs can occur in a "march" fashion as described by Jackson. On the other hand, seizures involving the associative cortex, having a less direct relation with the peripheral nervous system, and necessarily involving more widely distributed networks manifest with altered cognitive and/or behavioral signs whose neural substrate involves a network of cortical structures, as has been observed for normal cognitive processes. Other than the anatomical localization of these structures, the frequency of the discharge is a crucial determinant of semiological effect since a fast (gamma) discharge will tend to deactivate normal function, whereas a slower theta discharge can mimic physiological function. In terms of interaction between structures, the degree of synchronization plays a key role in clinical expression, as evidenced, for example, by studies of ictal fear-related behavior (decorrelation of activity between structures inducing "release" phenomena) and of déjà vu (increased synchronization). Studies of functional coupling within networks underlying complex ictal behavior indicate that the clinical semiology of a given seizure depends upon neither the anatomical origin of ictal discharge nor the target areas of its propagation alone but on the dynamic interaction between these. Careful mapping of the ictal network in its full spread offers essential information as to the localization of seizure onset, by deducing that a given network configuration could only be generated by a given area or group of areas. This article is part of a Special Issue entitled "NEWroscience 2013".
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The strange sensation of deja vu: not so strange in temporal lobe epilepsy
Moulin CJ
Journal of Neurology, Neurosurgery and Psychiatry 85(2): 132, 2014
doi: 10.1136/jnnp-2012-303876. Epub 2013 Mar 1.
Comment on "Is there anything distinctive about epileptic deja vu?" [Journal of Neurology, Neurosurgery and Psychiatry, 2014]
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The strange sensation of deja vu: not so strange in temporal lobe epilepsy
Moulin CJ
Journal of Neurology, Neurosurgery and Psychiatry Mar 1, 2013
[Epub ahead of print]
Abstract
Déjà vu is an infrequent and nebulous mental experience—a mismatch between subjective perceptions of memory and retrieval itself. [1] Relative to other memory errors and illusions, it has not received much attention in scientific works. However, one area where déjá vu has been studied consistently is temporal lobe epilepsy (TLE) [2] and in the spirit of Hughlings Jackson, Warren-Gash and Zeman[3] make an important contribution to this field.
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Is there anything distinctive about epileptic déjà vu?
Warren-Gash C1, Zeman A2
1 Research Department of Infection & Population Health, University College London, London, UK
2 Department of Neurology, Peninsula Medical School, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
Correspondence to Professor Adam Zeman, Department of Neurology, Peninsula Medical School, Peninsula College of Medicine and Dentistry, University of Exeter, Room F01, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK;
Journal of Neurology, Neurosurgery and Psychiatry 85: 143-147, 2014
doi:10.1136/jnnp-2012-303520
Abstract
Background
Déjà vu can occur as an aura of temporal lobe epilepsy and in some psychiatric conditions but is also common in the general population. It is unclear whether any clinical features distinguish pathological and physiological forms of déjà vu.
Methods
50 epileptic patients with ictal déjà vu, 50 non-epileptic patients attending general neurology clinics and 50 medical students at Edinburgh University were recruited. Data were collected on demographic factors, the experience of déjà vu using a questionnaire based on Sno's Inventory for Déjà Vu Experiences Assessment, symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale as well as seizure characteristics, anti-epileptic medications, handedness, EEG and neuroimaging findings for epileptic patients.
Results
73.5% of neurology patients, 88% of students and (by definition) all epilepsy patients had experienced déjà vu. The experience of déjà vu itself was similar in the three groups. Epileptic déjà vu occurred more frequently and lasted somewhat longer than physiological déjà vu. Epilepsy patients were more likely to report prior fatigue and concentrated activity, associated derealisation, olfactory and gustatory hallucinations, physical symptoms such as headaches, abdominal sensations and fear. After controlling for study group, anxiety and depression scores were not associated with déjà vu frequency.
Conclusions
Déjà vu is common and qualitatively similar whether it occurs as an epileptic aura or normal phenomenon. However ictal déjà vu occurs more frequently and is accompanied by several distinctive features. It is distinguished primarily by ‘the company it keeps.
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[Electroencephalographic characteristics of the deja vu phenomenon]
[Article in Russian]
Vlasov PN, Cherviakov AV, Gnezdinsii VV.
Zhurnal Nevrologii I Psikhiatrii Imeni SS Korsakova 113(4 Pt 2): 3-9, 2013
Abstract
Déjà vu (DV, from French "already seen") is an aberration of psychic activity associated with transitory erroneous perception of novel circumstances, objects, or people as already known. An aim of the study was to investigate EEG characteristics of DV in patients with epilepsy. We studied 166 people (63.2% women, mean age 25.17±9.19 years). The DV phenomenon was studied in patients (27 people) and in a control group (139 healthy people). Patients were interviewed for DV characteristics and underwent a long (12-16 h) ambulatory EEG-monitoring study. In EEG, DV episodes in patients began with polyspike activity in the right temporal lobe and, in some cases, ended with the slow-wave theta-delta activity in the right hemisphere.
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Comment on Brázdil (2012) "unveiling the mystery of dèjà-vù: the structural anatomy of dèjà-vù"
Labate A, Gambardella A.
Cortex 49(4): 1162, 2013
doi: 10.1016/j.cortex.2012.08.021. Epub 2012 Sep 3.
Comment on Unveiling the mystery of déjà vu: the structural anatomy of déjà vu. [Cortex. 2012]
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[Epilepsy in the temporal lobe: déjà vu in Primary Care]
[in Spanish]
Miguéns Blanco I1, Rodríguez Acevedo B.
1Medicina de Familia y Comunitaria, Centro de Salud de Matamá, Hospital Xeral-Cies, Vigo, España. Electronic address: iria.miguens a hotmail.com.
Semergen 39(7): e57-9, 2013
doi: 10.1016/j.semerg.2012.05.015. Epub 2012 Aug 10.
Abstract
Epilepsy is a common disease in the general population. 10% of the population will present a seizure throughout his life, although only 1% will have an epileptic condition. We can divide the generalized epilepsy and focal. Es in the latter that more diagnostic and management difficulties may arise in clinical practice, for its wide variety of symptoms and their identification difficult. These symptoms may be referred to differently by each patient, often dismissively. In focal epilepsy, the most prevalent epilepsy that originates in the temporal lobe. The identification and study of this pathology is very important because the patient may have episodes of disconnecting means and in one third of cases secondarily generalized crises. Although most patients the culprit lesion is mesial temporal sclerosis, one must rule out other causes such as tumors or infections.
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Persistent déjà vu associated with temporal lobe epilepsy in an adolescent
Akgül S, Oksüz Kanbur N, Turanlı G.
Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey. sinemhusnu at yahoo.com
Turkish Journal of Pediatrics 55(5): 552-4, 2013
Abstract
The term déjà vu is used to refer to the feeling of having already witnessed or experienced a current situation, despite the exact circumstances of the prior encounter being unclear. Although the déjà vu experience may be a benign occurrence, it may also be one of the first warning signs of a neurological event such as temporal lobe epilepsy. Symptoms of epilepsy may be difficult to recognize in children and adolescents, as not all seizures involve obvious convulsions. Sometimes symptoms are far more subtle, and these "hidden signs" may appear to fall within the range of normal childhood behavior, or in an adolescent, may be misinterpreted as psychological problems. We describe here an adolescent diagnosed with temporal lobe epilepsy who experienced persistent déjà vu at a young age. This case presents an interesting finding, as it shows that young adolescents are able to describe in detail an aura such as déjà vu that will allow physicians to identify the disorder much earlier.
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The boundaries of epilepsy: where is the limit? A reply to Labate and Gambardella
Brázdil M, Zeman A
Cortex 49(4): 1163-4, 2013
doi: 10.1016/j.cortex.2012.09.015. Epub 2012 Oct 8
Comment on
Unveiling the mystery of déjà vu: the structural anatomy of déjà vu. Brázdil et al Cortex. 2012 48(9): 1240-3. Epub 2012 Mar 14.
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First seizure while driving (FSWD)--an underestimated phenomenon?
Pohlmann-Eden B, Hynick N, Legg K.
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada. B.Pohlmann-Eden at dal.ca
Canadian Journal of Neurological Sciences 40(4): 540-5, 2013
Abstract
BACKGROUND:
Seizures while driving are a well known occurrence in established epilepsy and have significant impact on driving privileges. There is no data available on patients who experience their first (diagnosed) seizure while driving (FSWD).
METHOD:
Out of 311 patients presenting to the Halifax First Seizure Clinic between 2008 and 2011, 158 patients met the criteria of a first seizure (FS) or drug-naïve, newly diagnosed epilepsy (NDE). A retrospective chart review was conducted. FSWD was evaluated for 1) prevalence, 2) clinical presentation, 3) coping strategies, and 4) length of time driving before seizure occurrence.
RESULTS:
The prevalence of FSWD was 8.2%. All 13 patients experienced impaired consciousness. Eleven patients had generalized tonic-clonic seizures, one starting with a déjà-vu evolving to visual aura and a complex partial seizure; three directly from visual auras. Two patients had complex partial seizures, one starting with an autonomic seizure. In response to their seizure, patients reported they were i) able to actively stop the car (n=4, three had visual auras), ii) not able to stop the car resulting in accident (n=7), or iii) passenger was able to pull the car over (n=2). One accident was fatal to the other party. Twelve out of 13 patients had been driving for less than one hour.
DISCUSSION:
FSWD is frequent and possibly underrecognized. FSWD often lead to accidents, which occur less if preceded by simple partial seizures. Pathophysiological mechanisms remain uncertain; it is still speculative if complex visuo-motor tasks required while driving play a role in this scenario.
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Low penetrance of autosomal dominant lateral temporal epilepsy in Italian families without LGI1 mutations
Michelucci R, Pasini E, Malacrida S, Striano P, Bonaventura CD, Pulitano P, Bisulli F, Egeo G, Santulli L, Sofia V, Gambardella A, Elia M, de Falco A, Neve Al, Banfi P, Coppola G, Avoni P, Binelli S, Boniver C, Pisano T, Marchini M, Dazzo E, Fanciulli M, Bartolini Y, Riguzzi P, Volpi L, de Falco FA, Giallonardo AT, Mecarelli O, Striano S, Tinuper P, Nobile C.
Unit of Neurology, IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy. roberto.michelucci at ausl.bo.it
Epilepsia 54(7): 1288-97, 2013
doi: 10.1111/epi.12194. Epub 2013 Apr 26
Abstract
PURPOSE:
In relatively small series, autosomal dominant lateral temporal epilepsy (ADLTE) has been associated with leucine-rich, glioma-inactivated 1 (LGI1) mutations in about 50% of the families, this genetic heterogeneity being probably caused by differences in the clinical characteristics of the families. In this article we report the overall clinical and genetic spectrum of ADLTE in Italy with the aim to provide new insight into its nosology and genetic basis.
METHODS:
In a collaborative study of the Commission of Genetics of the Italian League Against Epilepsy (LICE) encompassing a 10-year period (2000-2010), we collected 33 ADLTE families, selected on the basis of the following criteria: presence of at least two members concordant for unprovoked partial seizures with prominent auditory and or aphasic symptoms, absence of any known structural brain pathology or etiology, and normal neurologic examination. The clinical, neurophysiologic, and neuroradiologic findings of all patients were analyzed and a genealogic tree was built for each pedigree. The probands' DNA was tested for LGI1 mutations by direct sequencing and, if negative, were genotyped with single-nucleotide polymorphism (SNP) array to search for disease-linked copy-number variation CNV. The disease penetrance in mutated and nonmutated families was assessed as a proportion of obligate carriers who were affected.
KEY FINDINGS:
The 33 families included a total of 127 affected individuals (61 male, 66 female, 22 deceased). The age at onset ranged between 2 and 60 years (mean 18.7 years). Ninety-one patients (72%) had clear-cut focal (elementary, complex, or secondarily generalized) seizures, characterized by prominent auditory auras in 68% of the cases. Other symptoms included complex visual hallucinations, vertigo, and déjà vu. Aphasic seizures, associated or not with auditory features, were observed in 20% of the cases, whereas tonic-clonic seizures occurred in 86% of the overall series. Sudden noises could precipitate the seizures in about 20% of cases. Seizures, which usually occurred at a low frequency, were promptly controlled or markedly improved by antiepileptic treatment in the majority of patients. The interictal electroencephalography (EEG) studies showed the epileptiform temporal abnormalities in 62% of cases, with a slight predominance over the left region. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans were negative. LGI1 mutations (missense in nine and a microdeletion in one) were found in only 10 families (30%). The patients belonging to the mutated and not mutated groups did not differ except for penetrance estimate, which was 61.3% and 35% in the two groups, respectively (chi-square, p = 0.017). In addition, the disease risk of members of families with mutations in LGI1 was three times higher than that of members of LGI1-negative families (odds ratio [OR] 2.94, confidence interval [CI] 1.2-7.21).
SIGNIFICANCE:
A large number of ADLTE families has been collected over a 10-year period in Italy, showing a typical and homogeneous phenotype. LGI1 mutations have been found in only one third of families, clinically indistinguishable from nonmutated pedigrees. The estimate of penetrance and OR, however, demonstrates a significantly lower penetrance rate and relative disease risk in non-LGI1-mutated families compared with LGI1-mutated pedigrees, suggesting that a complex inheritance pattern may underlie a proportion of these families.
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Differentiating ictal panic with low-grade temporal lobe tumors from psychogenic panic attacks
Ghods AJ, Ruban DS, Wallace D, Byrne RW
Department of Neurosurgery, Rush University Medical Center, 1653 West Congress Pkwy, Chicago, IL 60612-3244 alijghods at hotmail.com.
Journal of Clinical Psychiatry 74(11): 1071-5, 2013
doi: 10.4088/JCP.13m08378
Abstract
OBJECTIVE:
Indolent low-grade temporal lobe tumors may present with ictal panic that may be difficult to differentiate from psychogenic panic attacks. The current study aims to demonstrate the differences between the two disorders and help physicians generate a diagnostic paradigm.
METHOD:
This was a retrospective study of 43 patients who underwent a temporal lobectomy between 1981 and 2008 for the treatment of intractable temporal lobe epilepsy secondary to low-grade neoplasms at Rush University Medical Center. A total of 10 patients in this group presented with ictal panic who were previously being treated for psychogenic panic attacks. Medical records were reviewed for age at seizure onset, duration of symptoms, lateralization of the epileptogenic zone, pathological diagnosis, and postsurgical seizure outcome according to the modified Engel classification.
RESULTS:
Neuropathologic findings of the 10 tumors were pleomorphic xanthoastrocytoma, ganglioglioma, oligodendroglioma, and dysembryoplastic neuroepithelial. The mean age of the patients undergoing surgery was 28 years (range, 15-49). The mean duration of panic symptoms prior to surgery was 9.8 years (range, 3-23). All patients had unprovoked ictal panic. None had symptoms suggestive of a brain tumor, such as signs of increased intracranial pressure or any focal neurologic deficit. In 5 of the patients, other symptoms associated with the ictal panic, including unusual sounds, nausea, automatism, uprising gastric sensation, and déjà vuwere identified. Gross total resection of the lesion resulted in improved seizure outcome in all patients undergoing surgery. Patient follow-up was, on average, 7.4 years (range, 2-14) from time of surgery.
CONCLUSIONS:
Although similar, ictal panic from epilepsy and classic panic attacks are clinically distinguishable entities with different modalities of treatment. A careful history may help differentiate patients with ictal panic from those with psychogenic panic attacks and determine for which patients to obtain neuroimaging studies.
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Déjà vu phenomenon-related EEG pattern. Case report
Vlasova PN [a], Chervyakovb AV [b], Gnezditskiib VV [b]
a Moscow State University of Medicine and Dentistry, Moscow, Russia
b Research Center of Neurology, Russian Academy of Medical Sciences, Moscow, Russia
Epilepsy & Behavior Case Reports 1: 136–141, 2013
DOI: 0.1016/j.ebcr.2013.08.001
Abstract
Background
Déjà vu (DV, from French déjà vu — “already seen”) is an aberration of psychic activity associated with transitory erroneous perception of novel circumstances, objects, or people as already known.
Objective
This study aimed to record the EEG pattern of déjà vu.
Methods
The subjects participated in a survey concerning déjà vu characteristics and underwent ambulatory EEG monitoring (12–16 h).
Results
In patients with epilepsy, DV episodes began with polyspike activity in the right temporal lobe region and, in some cases, ended with slow-wave theta–delta activity over the right hemisphere. There were no epileptic discharges in healthy respondents during DV.
Conclusion
Two types of déjà vu are suggested to exist: “pathological-epileptic” déjà vu, characteristic of patients with epilepsy and equivalent to an epileptic seizure, and “nonpathological-nonepileptic” déjà vu, which is characteristic of healthy people and psychological phenomenon.
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Déjà vu in unilateral temporal-lobe epilepsy is associated with selective familiarity impairments on experimental tasks of recognition memory
Martin CB, Seyed MM, Pruessner JC, Pietrantonio S, Burneo JG, Hayman-Abello B, Köhler S
The Brain and Mind Institute and Department of Psychology, University of Western Ontario, London, Ontario, Canada
Neuropsychologia 50(13): 2981-91, 2012
doi: 10.1016/j.neuropsychologia.2012.07.030. Epub 2012 Jul 27.
Abstract
In Déjà vu, a phenomenological impression of familiarity for the current visual environment is experienced with a sense that it should in fact not feel familiar. The fleeting nature of this phenomenon in daily life, and the difficulty in developing experimental paradigms to elicit it, has hindered progress in understanding déjà vu. Some neurological patients with temporal-lobe epilepsy (TLE) consistently experience déjà vu at the onset of their seizures. An investigation of such patients offers a unique opportunity to shed light on its possible underlying mechanisms. In the present study, we sought to determine whether unilateral TLE patients with déjà vu (TLE+) show a unique pattern of interictal memory deficits that selectively affects familiarity assessment. In Experiment 1, we employed a Remember Know paradigm for categorized visual scenes and found evidence for impairments that were limited to familiarity-based responses. In Experiment 2, we administered an exclusion task for categorized visual scenes that placed both recognition processes in opposition. TLE+ patients again displayed recognition impairments, and these impairments spared their ability to engage recollective processes so as to counteract familiarity. The selective deficits we observed in TLE+ patients contrasted with the broader pattern of recognition-memory impairments that was present in a control group of unilateral patients without déjà vu (TLE-). MRI volumetry revealed that ipsilateral medial temporal structures were less affected in TLE+ than in TLE- patients, with a trend for more focal volume reductions in the rhinal cortices of the former group. The current findings establish a first empirical link between déjà vu in TLE and processes of familiarity assessment, as defined and measured in current cognitive models. They also reveal a pattern of selectivity in recognition impairments that is rarely observed and, thus, of significant theoretical interest to the memory literature at large.
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Déjà experiences in temporal lobe epilepsy
Illman NA1, Butler CR2, Souchay C1, Moulin CJ1
1 Leeds Memory Group, Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, UK
2 Department of Clinical Neurology, University of Oxford, Oxford OX3 9DU, UK
Epilepsy Research and Treatment 2012 Epub 2012 Mar 20
http://dx.doi.org/10.1155/2012/539567 http://www.hindawi.com/journals/ert/2012/539567/
Abstract
Historically, déjà vu has been linked to seizure activity in temporal lobe epilepsy, and clinical reports suggest that many patients experience the phenomenon as a manifestation of simple partial seizures. We review studies on déjà vu in epilepsy with reference to recent advances in the understanding of déjà vu from a cognitive and neuropsychological standpoint. We propose a decoupled familiarity hypothesis, whereby déjà vuis produced by an erroneous feeling of familiarity which is not in keeping with current cognitive processing. Our hypothesis converges on a parahippocampal dysfunction as the locus of déjà vu experiences. However, several other temporal lobe structures feature in reports of déjà vu in epilepsy. We suggest that some of the inconsistency in the literature derives from a poor classification of the various types of déjà experiences. We propose déjà vu/déjà vécu as one way of understanding déjà experiences more fully. This distinction is based on current models of memory function, where déjà vu is caused by erroneous familiarity and déjà vécu by erroneous recollection. Priorities for future research and clinical issues are discussed.
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Rhinal–hippocampal interactions during déjà vu
Bartolomei F, Barbeau EJ, Nguyen T, McGonigal A, Régis J, Chauvel P, Wendling F
INSERM, U751, Laboratoire de Neurophysiologie et Neuropsychologie, Marseille F-13005, France E-mail: fabrice.bartolomei a ap-hm.fr
Clinical Neurophysiology 123(3): 489-495, 2012
Abstract
Objective
The phenomenon of ‘déjà vu’ is caused by acute disturbance of mnemonic systems of the medial temporal lobe (MTL). In epileptic patients investigated with intracerebral electrodes, déjà vucan be more readily induced by stimulation of the rhinal cortices (RCs) than the hippocampus (H). Whether déjà vu results from acute dysfunction of the familiarity system alone (sustained by RC) or from more extensive involvement of the MTL region (including H) is debatable.
Methods
We analysed the synchronisation of intracerebral electroencephalography (EEG) signals recorded from RC, H and amygdala (A) in epileptic patients in whom déjà vu was induced by electrical stimulation. EEG signal correlations (between signals from RC, A and H) were evaluated using a nonlinear regression.
Results
In comparison with RC stimulations that did not lead to déjà vu (DV-), stimulations triggering déjà vu (DV+) were associated with increased broadband EEG correlation (p=0.01). Changes in correlations were significantly different in the theta band for RC–A (p=0.007) and RC–H (p=0.01) and in the beta band for RC–H (p=0.001) interactions.
Conclusion
Déjà vu is associated with increased EEG signal correlation between MTL structures.
Significance
Results are in favour of a mechanism involving transient co-operation between various MTL structures, not limited to RC alone.
Abbreviations: H, hippocampus, RC, rhinal cortex, EC, entorhinal cortex, A, amygdala, h2, coefficient of nonlinear correlation, MTL, medial temporal lobe, DV, déjà vu
Keywords: Déjà vu, Entorhinal, Hippocampus, Synchrony, Theta, Autobiographic memory
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Childhood febrile convulsions and déjà vu in adulthood
Dubrey SW, Abdel-Gadir A, Rakowicz WP
Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, UK.
British Journal of Hospital Medicine (London) 72(4): 232-3, 2011
Abstract
Temporal lobe epilepsy may comprise simple partial seizures without loss of awareness or complex partial seizures with a loss of awareness. Complex partial seizures may evolve into a generalized tonic-clonic seizure. Aura is a feature of the majority of temporal lobe seizures. Most auras and automatisms last a very short period, from a few seconds to 1-2 minutes. This article reports a young woman who experienced a generalized grand mal seizure after 20 years of approximately fortnightly déjà vu phenomena, and describes the association of temporal lobe epilepsy with childhood febrile convulsions.
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The “dreamy state” in the work of John Hughlings Jackson
York GK 3rd
Journal of the History of the Neurosciences 20(4): 381-2, 2011
doi: 10.1080/0964704X.2011.618488
Comment on
An approach to nineteenth-century medical lexicon: the term "dreamy state". [J Hist Neurosci. 2011]
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Familial temporal lobe epilepsy with psychic auras associated with a novel LGI1 mutation
Striano P, Busolin G, Santulli L, Leonardi E, Coppola A, Vitiello L, Rigon L, Michelucci R, Tosatto SC, Striano S, Nobile C.
CNR-Istituto di Neuroscienze, Dipartimento di Scienze Biomediche Sperimentali, Università di Padova, viale G. Colombo 3, 35121 Padova, Italy.
Neurology 76(13): 1173-6, 2011
doi: 10.1212/WNL.0b013e318212ab2e.
Abstract
BACKGROUND:
Autosomal dominant lateral temporal epilepsy (ADLTE) is characterized by focal seizures with auditory features or aphasia. Mutations in the LGI1 gene have been reported in up to 50% of ADLTE pedigrees. We report a family with temporal lobe epilepsy characterized by psychic symptoms associated with a novel LGI1 mutation.
METHODS:
All participants were personally interviewed and underwent neurologic examination and video-EEG recordings. LGI1 exons were sequenced by standard methods. Mutant cDNA was transfected into human embryonic kidney 293 cells; both cell lysates and media were analyzed by Western blot. In silico modeling of the Lgi1 protein EPTP domain was carried out using the structure of WD repeat protein and manually refined.
RESULTS:
Three affected family members were ascertained, 2 of whom had temporal epilepsy with psychic symptoms (déjà vu, fear) but no auditory or aphasic phenomena, while the third had complex partial seizures without any aura. In all patients, we found a novel LGI1 mutation, Arg407Cys, which did not hamper protein secretion in vitro. Mapping of the mutation on a 3-dimensional protein model showed that this mutation does not induce large structural rearrangements but could destabilize interactions of Lgi1 with target proteins.
CONCLUSIONS:
The Arg407Cys is the first mutation with no effect on Lgi1 protein secretion. The uncommon, isolated psychic symptoms associated with it suggests that ADLTE encompasses a wider range of auras of temporal origin than hitherto reported.
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Transient epileptic amnesia: déjà vu heralding recovery of lost memories
Milton F, Butler CR, Zeman AZ
Journal of Neurology, Neurosurgery and Psychiatry 82(10): 1178-9, 2011
doi: 10.1136/jnnp.2009.200147. Epub 2010 Jun 28
(Letter to the editor; available on-line at http://jnnp.bmj.com/content/82/10/1178)
Transient epileptic amnesia (TEA) is a form of temporal lobe epilepsy in which the main and sometimes only manifestation of the seizure is a period of amnesia, usually lasting less than 1 h, during which other cognitive functions remain intact. Attacks are frequent, often occur on waking and typically respond promptly to anticonvulsants. Patients with TEA often complain of persistent interictal remote memory impairment and accelerated forgetting of new information.[1]
Déjà vu is the disconcerting feeling that our current experience echoes some ill-defined past experience.[2] Déjà vu can be subdivided into a form related to the processing of familiarity, true déjà vu and a form related to the processing of recollection, “déjà vécu” (“already lived”).[3] Many healthy people experience déjà vuoccasionally, and it is sometimes a symptom of temporal lobe epilepsy.[2] However, in a recent study, no patients with TEA reported clear-cut déjà vu in relation to their amnestic seizures.[1] This could relate to the fact that déjà vu is more prevalent in younger people while TEA is a late onset disorder or to the pathophysiology of amnestic seizures.
We report a patient with TEA who experienced episodes of déjà vu approximately 5 years after cessation of his amnestic attacks. After these episodes, he recovered …
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Familial mesial temporal lobe epilepsy: a benign epilepsy syndrome showing complex inheritance
Crompton DE, Scheffer IE, Taylor I, Cook MJ, McKelvie PA, Vears DF, Lawrence KM, McMahon JM, Grinton BE, McIntosh AM, Berkovic SF
Department of Medicine and Epilepsy Research Centre, University of Melbourne, Austin Health, West Heidelberg, Victoria, Australia. E-mail: douglas.crompton a ncl.ac.uk
Brain 133(11): 3221-31, 2010
Abstract
Temporal lobe epilepsy is the commonest partial epilepsy of adulthood. Although generally perceived as an acquired disorder, several forms of familial temporal lobe epilepsy, with mesial or lateral seizure semiology, have been described. Descriptions of familial mesial temporal lobe epilepsy have varied widely from a benign epilepsy syndrome with prominent déjà vu and without antecedent febrile seizures or magnetic resonance imaging abnormalities, to heterogeneous, but generally more refractory epilepsies, often with a history of febrile seizures and with frequent hippocampal atrophy and high T2 signal on magnetic resonance imaging. Compelling evidence of a genetic aetiology (rather than chance aggregation) in familial mesial temporal lobe epilepsy has come from twin studies. Dominant inheritance has been reported in two large families, though the usual mode of inheritance is not known. Here, we describe clinical and neurophysiological features of 20 new mesial temporal lobe epilepsy families including 51 affected individuals. The epilepsies in these families were generally benign, and febrile seizure history was infrequent (9.8%). No evidence of hippocampal sclerosis or dysplasia was present on brain imaging. A single individual underwent anterior temporal lobectomy, with subsequent seizure freedom and histopathological evidence of hippocampal sclerosis was not found. Inheritance patterns in probands' relatives were analysed in these families, together with 19 other temporal lobe epilepsy families previously reported by us. Observed frequencies of epilepsies in relatives were lower than predicted by dominant Mendelian models, while only a minority (8/39) of families could be compatible with recessive inheritance. These findings strongly suggest that complex inheritance, similar to that widely accepted in the idiopathic generalized epilepsies, is the usual mode of inheritance in familial mesial temporal lobe epilepsy. This disorder, which appears to be relatively common, and not typically associated with hippocampal sclerosis, is an appropriate target for contemporary approaches to complex disorders such as genome-wide association studies for common genetic variants or deep sequencing for rare variants.
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Déjà-vu in temporal lobe epilepsy: metabolic pattern of cortical involvement in patients with normal brain MRI
Guedj E, Aubert S, McGonigal A, Mundler O, Bartolomei F.
Service Central de Biophysique et Médecine Nucléaire, CHU Timone & Centre Européen de Recherche en Imagerie Médicale, CERIMED & Centre d'Investigation Clinique, CIC, INSERM, Université de la Méditerranée, Marseille F-13000, France. E-mail: eric.guedj a ap-hm.fr
Neuropsychologia 48(7): 2174-81, 2010
Epub 2010 Apr 14
Abstract
To contribute to the identification of brain regions involved in déjà-vu, we studied the metabolic pattern of cortical involvement in patients with seizures of temporal lobe origin presenting with or without déjà-vu. Using voxel-based analysis of 18FDG-PET brain scans, we compared glucose metabolic rate of 8 patients with déjà-vu, 8 patients without déjà-vu, and 20 age-matched healthy subjects. Patients were selected after comprehensive non-invasive presurgical evaluation, including normal brain MRI and surface electroclinical features compatible with unilateral temporal lobe epilepsy (TLE). Patients with and without déjà-vu did not differ in terms of age, gender, epilepsy lateralization, epilepsy onset, epilepsy duration, and other subjective ictal manifestations. TLE patients with déjà-vu exhibited ipsilateral hypometabolism of superior temporal gyrus and of parahippocampal region, in the vicinity of perirhinal/entorhinal cortex, in comparison either to healthy subjects or to TLE patients without déjà-vu (p<0.05 FDR-corrected). By contrast, no difference was found between patient subgroups for hypometabolism of hippocampus and amygdala. At an individual-level, in comparison to healthy subjects, hypometabolism of both parahippocampal region and superior temporal gyrus was present in 7/8 patients with déjà-vu. Hippocampal metabolism was spared in 3 of these 7 patients. These findings argue for metabolic dysfunction of a medial-lateral temporal network in patients with déjà-vu and normal brain MRI. Within the medial temporal lobe, specific involvement of the parahippocampal region, often in the absence of hippocampal impairment, suggests that the feeling of familiarity during seizures greatly depends on alteration of the recognition memory system.
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Scientific Theories on the Déjà Vu Phenomenon
Redgård R
Masters thesis: University of Skövde, School of Humanities and Informatics, June, 2010
http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-3918
Abstract
The term ”déjà vu” was first introduced around the 1890s in order to separate the phenomenon from other paramnesias, but a clear consensus on its definition was not reached until mid 20th century. Since the middle of the 19th century, several dozens of parapsychological, pseudoscientific and scientific theories have been proposed to explain the déjà vu phenomenon, ranging from “messages from God” to “delayed neural transmission speed”. Most scientific theories can be divided into four categories: dual-processing,neurological, memory and attentional. This paper discusses and compares some of these theories. Memory and attentional theories are concluded to have most explanatory power and potential to demystify the phenomenon through future research.
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Ictal mnemestic aura and verbal memory function
Vederman AC, Holtzer R, Zimmerman ME, Devinsky O, Barr WB
New York University Comprehensive Epilepsy Center, New York, NY, USA. E-mail: aaronved a med.umich.edu
Epilepsy & Behavior 17(4): 474-7, 2010
Epub 2010 Mar 6
Abstract
Déjà vu aura is a well-known phenomenon experienced by some patients with epilepsy. This study sought to explore the relationship between verbal memory and the experience of déjà vuor other types of mnemestic auras in 42 individuals with intractable seizures and 42 age- and education-matched patient controls. Verbal memory was assessed with indices of learning, long delay recall, and recognition from the California Verbal Learning Test. Results indicated that auras of any type were not associated with memory performance on the California Verbal Learning Test. As expected, age and education were related to verbal memory performance. Mnemestic auras were associated with clinical indices of illness, suggesting that the presence of these auras may be regarded as a risk factor for greater chronicity and severity in epilepsy.
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Epilepsy: creative sparks
Thomas RH, Mullins JM, Waddington T, Nugent K, Smith PE.
Wales Epilepsy Research Network, Institute of Life Sciences, Swansea University, Swansea, UK. rhys-thomas at doctors.org.uk
Practical Neurology 10(4): 219-26, 2010
doi: 10.1136/jnnp.2010.217984
Abstract
An epilepsy diagnosis is very verbal, relying on witness history, personal narrative and analysis of how people describe the experience. Occasionally however, non-verbal descriptions of seizures allow us to gain a fuller understanding of this complex disorder. Artists are often inspired by personal experience, so it should be no surprise to find people depicting images of ill health, both their own and people they have observed. Furthermore, an ailment or affliction may influence an artist's portfolio over their lifetime, such as de Kooning's Alzheimer's disease and Monet's glaucoma. Epilepsy (in contrast with cerebrovascular or neurodegenerative disease) may present not just with a loss of function but with unusual super-added experiences such as déjà vu, ecstatic auras or hallucinations. Here we describe some artists who were thought to have had epilepsy, and the way in which their seizures influenced their art. It appears that for some, they have succeeded despite, rather than because of, their epilepsy and that rather than be inspired by their symptoms they were ashamed of them. If there is a common theme, it is in the unwanted psychological harm of some seizures provoking dark, frustrated imagery.
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Two forms of déjà vu experiences in patients with epilepsy
Adachi N, Akanuma N, Ito M, Adachi T, Takekawa Y, Adachi Y, Matsuura M, Kanemoto K, Kato M
Adachi Mental Clinic, Sapporo, Japan. E-mail: adacchan a tky2.3web.ne.jp
Epilepsy & Behavior 18(3): 218-22, 2010
Epub 2010 May 21
Abstract
Persons with epilepsy experience déjà vu phenomena with or without seizure recognition. Déjà vu experiences are also common mental phenomena in nonclinical individuals. The purpose of this study was to clarify two forms of déjà vu experiences in persons with epilepsy. Déjà vu experiences of 312 patients with epilepsy and 402 nonclinical individuals were evaluated using the Inventory of Déjà vu Experiences Assessment. In the patients with epilepsy, characteristics of déjà vu experiences with seizure recognition (SR form) were compared with those experiences with no seizure recognition (NSR form). The incidence (63.1%) of déjà vu experiences in patients with epilepsy was significantly lower than that (76.1%) of nonclinical individuals (chi(2)=14.2, P=0.000). Among the patients with epilepsy, 55.6% had the NSR form and 24.0% had the SR form. Those with the NSR form manifested fewer psychopathological characteristics than did those with the SR form. Patients tended to view the SR form more negatively (i.e., frightened, uncomfortable, or disturbed) than the NSR form. The NSR form was significantly associated with idiopathic generalized epilepsies, less frequent antiepileptic drug administration, and no mesial temporal sclerosis. Although there was a significant association between the frequency of the SR form and patients' habitual seizures, the frequency of the NSR form was not associated with the frequency of the patients' habitual seizures. Persons with epilepsy experience two forms of déjà vuwhich are differently associated with their seizure recognition.
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Mémoire et épilepsie [Memory and epilepsy] [in French]
Dupont S
Biologie Aujourd'hui 204(2): 181- 8, 2010
Abstract
Medial temporal lobe epilepsy is a chronic neurological disease that begins in the early age and that is associated with frequent and disturbing memory deficits. Repeated seizures will lead to the formation of an epileptogenic network that may interfere with physiological neuronal networks and thus with normal brain function: by direct activation or indirectly by deactivation during a seizure, see for example the dreamy state or the ''déja vécu'' phenomenon during temporal seizures; by ictal or post-ictal inhibition, see for example ictal or post-ictal amnesia; by a repetitive and chronic modulation leading to a reorganization of the physiological neuronal networks. The study of these interactions between epileptic and physiological neural networks must lead to better explore the patient's memory and predict memory worsening before temporal lobe surgery and to better understand the reorganization of memory networks in chronic epilepsy. The goal is double: (1) improve the prediction of post-operative memory worsening and guide rehabilitation in epileptic clinical practice; (2) improve the pathophysiological knowledge about memory processes.
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Phenomenology of hallucinations, illusions, and delusions as part of seizure semiology
Kasper BS, Kasper EM, Pauli E, Stefan H.
Epilepsy Center, Department of Neurology, Friedrich Alexander University, Schwabachanlage 6, Erlangen, Germany. E-mail: burkhard.kasper a uk-erlangen.de
Epilepsy & Behavior 18(1-2): 13-23, 2010
Epub 2010 May 18.
Abstract
In partial epilepsy, a localized hypersynchronous neuronal discharge evolving into a partial seizure affecting a particular cortical region or cerebral subsystem can give rise to subjective symptoms, which are perceived by the affected person only, that is, ictal hallucinations, illusions, or delusions. When forming the beginning of a symptom sequence leading to impairment of consciousness and/or a classic generalized seizure, these phenomena are referred to as an epileptic aura, but they also occur in isolation. They often manifest in the fully awake state, as part of simple partial seizures, but they also can be associated to different degrees of disturbed consciousness. Initial ictal symptoms often are closely related to the physiological functions of the cortical circuit involved and, therefore, can provide localizing information. When brain regions related to sensory integration are involved, the seizure discharge can cause specific kinds of hallucinations, for example, visual, auditory, gustatory, olfactory, and cutaneous sensory sensations. In addition to these elementary sensory perceptions, quite complex hallucinations related to a partial seizure can arise, for example, perception of visual scenes or hearing music. By involving psychic and emotional spheres of human perception, many seizures also give rise to hallucinatory emotional states (e.g., fear or happiness) or even more complex hallucinations (e.g., visuospatial phenomena), illusions (e.g., déjà vu, out-of-body experience), or delusional beliefs (e.g., identity change) that often are not easily recognized as epileptic. Here we suggest a classification into elementary sensory, complex sensory, and complex integratory seizure symptoms. Epileptic hallucinations, illusions, and delusions shine interesting light on the physiology and functional anatomy of brain regions involved and their functions in the human being. This article, in which 10 cases are described, introduces the fascinating phenomenology of subjective seizure symptoms.
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Hyperfamiliarity for faces (HFF) in epilepsy - left temporal localization?
Devinsky O, Davachi L, Santchi C, Quinn BT, Staresina BP, Thesen T
Neurology 74: 970-974, 2010
Abstract
Authors cite that the hippocampus is important for recollection and the perirhinal cortex for feeling of familiarity. Déjà vu and déjà vécu occur more often with right hemisphere lesions establishing "right sided dominance for familiarity." The normal electrical response for familiarity is suppression vs. activation for novelty stimulus. Authors speculate the left (impaired) side is unable to recognize faces (novelty signallig) whereas the right (unimpaired) side is in overdrive and falsely signal familiarity. Patients quickly accept their familiarity is false, due to intact right hemisphere structures otherwise. Contrtast to reduplication syndromes (Capgras) with right hemispheric and bifrontal abnormality.
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Posttraumatic stress disorder caused by the misattribution of seizure-related experiential responses
Cohen ML, Rozensky RH, Zlatar ZZ, Averbuch RN, Cibula JE.
Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610-0165, USA. mlcohen at phhp.ufl.edu
Epilepsy & Behavior 9(4): 652-5, 2010
doi: 10.1016/j.yebeh.2010.09.029. Epub 2010 Oct 28
Abstract
Patients with temporal lobe seizures sometimes experience what John Hughlings Jackson described as "dreamy states" during seizure onset. These phenomena may be characterized by a re-experiencing of past events, feelings of familiarity (déjà vu), and hallucinations. In previous reports, patients have been aware of the illusory nature of their experiences. Here, however, the case of a patient with a documented 37-year history of temporal lobe epilepsy who is not aware is described. Fifteen years ago, the patient saw visions of traumatic autobiographical events that he had never previously recalled. He believed them to be veridical memories from his childhood, although evidence from his family suggests that they were not. The patient's psychological reaction to the "recovery" of these traumatic "memories" was severe enough to qualify as posttraumatic stress disorder (PTSD). To our knowledge, this is the first report of PTSD caused by the misattribution of mental states that accompany a seizure.
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Isolated amygdala neurocysticercosis in a patient presenting with déjà vu and olfactory auras. Case report
Lee DJ, Owen CM, Khanifar E, Kim RC, Binder DK
Department of Neurological Surgery, University of California, Irvine, CA, USA
Journal of Neurosurgery: Pediatrics 3(6): 538-41, 2009
Abstract
Neurocysticercosis is the most common parasitic infection in the CNS and a leading cause of epilepsy. Since it is a circumscribed lesional cause of epilepsy, specific locations of neurocysticercal lesions may lead to specific clinical presentations. The authors describe a 17-year-old Hispanic boy who had a single enhancing bilobar mass in the right amygdala. Initially, the patient presented with secondarily generalized tonic-clonic seizures, which resolved with antiepilepsy drug therapy. On further investigation, he was found to have persistent olfactory and déjà vu auras. A right amygdalectomy without hippocampectomy was performed, and both the seizures and auras immediately resolved. Pathological analysis revealed neurocysticercosis. To the authors' knowledge, this case is the first reported instance of 2 distinct mesial temporal aura semiologies associated with localized neurocysticercosis in the amygdala and successfully treated with resection. Uniquely, the case demonstrates that both olfactory and déjà vu auras can emanate from the amygdala.
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[Clinical features in a Japanese patient with autosomal dominant lateral temporal epilepsy having LGI1 mutation] [in Japanese]
Fujita Y, Ikeda A, Kadono K, Kawamata J, Tomimoto H, Fukuyama H, Takahashi R
Department of Neurology, Kyoto University Graduate School of Medicine
Rinsho Shinkeigaku 49(4): 186-90, 2009
Abstract
We described a clinical feature of autosomal dominant lateral temporal epilepsy (ADLTE) in a Japanese patient having LGI1 mutation. The patient was a 27-year-old woman who had her first seizure at the age of 10 years, a nocturnal generalized seizure. She then had partial seizures manifesting auditory symptoms with or without anxiety, panic attack, déjà vu, sensory aphasia and visual symptoms. Repeated EEGs were normal. Brain MRI showed small left superior temporal gyrus. 18F-deoxyglucose positron emission tomography (PDG-PET) demonstrated glucose hypometabolism in the left lateral temporal lobe. Sequencing of the LGI1 revealed a single base substitution in exon 8 (1642C-->T) causing missense mutation at residue 473 of the LGI1 protein (S473 L). When one demonstrates ictal symptoms arising from the lateral temporal to occipital area with psychotic symptoms, ADLTE should be suspected and a detailed family history is warranted.
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Computer modelling of epilepsy
Lytton WW
Department of Physiology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA. E-mail: billl a neurosim.downstate.edu
Nature Reviews Neuroscience 9(8): 626-37, 2008
Epub 2008 Jul 2
Abstract
Epilepsy is a complex set of disorders that can involve many areas of the cortex, as well as underlying deep-brain systems. The myriad manifestations of seizures, which can be as varied as déjà vu and olfactory hallucination, can therefore give researchers insights into regional functions and relations. Epilepsy is also complex genetically and pathophysiologically: it involves microscopic (on the scale of ion channels and synaptic proteins), macroscopic (on the scale of brain trauma and rewiring) and intermediate changes in a complex interplay of causality. It has long been recognized that computer modelling will be required to disentangle causality, to better understand seizure spread and to understand and eventually predict treatment efficacy. Over the past few years, substantial progress has been made in modelling epilepsy at levels ranging from the molecular to the socioeconomic. We review these efforts and connect them to the medical goals of understanding and treating the disorder.
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The persistence of erroneous familiarity in an epileptic male: challenging perceptual theories of déjà vuactivation
O'Connor AR, Moulin CJ
Department of Psychology, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA. E-mail: aoconnor a artsci.wustl.edu
Brain and Cognition 68(2): 144-7, 2008
Abstract
We report the case of a 39-year-old, temporal lobe epileptic male, MH. Prior to complex partial seizure, experienced up to three times a day, MH often experiences an aura experienced as a persistent sensation of déjà vu. Data-driven theories of déjà vu formation suggest that partial familiarity for the perceived stimulus is responsible for the sensation. Consequently, diverting attention away from this stimulus should cause the sensation to dissipate. MH, whose sensations of déjà vu persist long enough for him to shift his perceptual focus a number of times during the experience, spontaneously reports that these shifts make no difference to the sensation experienced. This novel observation challenges data-driven theories of déjà vu formation which have been used to explain the occurrence of déjà vu in those with temporal lobe epilepsy and the general population. Clearly, in epilepsy, erratic neuronal firing is the likely contributor, and in this paper we postulate that such brain firing causes higher-order erroneous 'cognitive feelings'. We tentatively extend this account to the general population. Rather than being a reaction to familiar elements in perceptual stimuli, déjà vu is likely to be the result of a cognitive feeling borne of the erroneous activation of neural familiarity circuits such as the parahippocampal gyrus, persisting as long as this activation persists.
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Cat scratch disease presenting as acute encephalopathy
Cherinet Y, Tomlinson R
Department of Paediatrics, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol BS28BJ, UK. yonasc a hotmail.com
Emergency Medicine Journal 25(10): 703-704, 2008
http://search.proquest.com/docview/69650759?accountid=14616
Abstract
An unusual case of primary meningo-encephalitis followed by partial complex seizure in a 9-year-old boy was found to be a symptom of cerebral Bartonella henselae infection or cat scratch disease. Despite one clinical relapse at 4 weeks post-presentation, he remained seizure free on carbamazepine for one year. Six months after stopping carbamazepine, however, he developed deja vu phenomena and absence seizures with EEG abnormality. Restarting carbamazepine improved his symptoms.
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Familial mesial temporal lobe epilepsy maps to chromosome 4q13.2-q21.3
Hedera P, Blair MA, Andermann E, Andermann F, D'Agostino D, Taylor KA, Chahine L, Pandolfo M, Bradford Y, Haines JL, Abou-Khalil B
Department of Neurology, Vanderbilt University, Nashville, TN 37232- 8552, USA. E-mail: peter.hedera a vanderbilt.edu
Neurology 68(24): 2107-12, 2007
Epub 2007 Mar 21
Abstract
PURPOSE: To report results of linkage analysis in a large family with autosomal dominant (AD) familial mesial temporal lobe epilepsy (FMTLE).
BACKGROUND: Although FMTLE is a heterogeneous syndrome, one important subgroup is characterized by a relatively benign course, absence of antecedent febrile seizures, and absence of hippocampal sclerosis. These patients have predominantly simple partial seizures (SPS) and infrequent complex partial seizures (CPS), and intense and frequent déjà vu phenomenon may be the only manifestation of this epilepsy syndrome. No linkage has been described in this form of FMTLE.
METHODS: We identified a four-generation kindred with several affected members meeting criteria for FMTLE and enrolled 21 individuals who gave informed consent. Every individual was personally interviewed and examined; EEG and MRI studies were performed on three affected subjects. DNA was extracted from every enrolled individual. We performed a genome-wide search using an 8 cM panel and fine mapping was performed in the regions with a multipoint lod score >1. We sequenced the highest priority candidate genes.
RESULTS: Inheritance was consistent with AD mode with reduced penetrance. Eleven individuals were classified as affected with FMTLE and we also identified two living asymptomatic individuals who had affected offspring. Seizure semiologies included predominantly SPS with déjà vu feeling, infrequent CPS, and rare secondarily generalized tonic-clonic seizures. No structural abnormalities, including hippocampal sclerosis, were detected on MRI performed on three individuals. Genetic analysis detected a group of markers with lod score >3 on chromosome 4q13.2-q21.3 spanning a 7 cM region. No ion channel genes are predicted to be localized within this locus. We sequenced all coding exons of sodium bicarbonate cotransporter (SLC4A) gene, which plays an important role in tissue excitability, and cyclin I (CCNI), because of its role in the cell migration and possibility of subtle cortical abnormalities. No disease-causing mutations were identified in these genes.
CONCLUSION: We report identification of a genetic locus for familial mesial temporal lobe epilepsy. The identification of a disease-causing gene will contribute to our understanding of the pathogenesis of temporal lobe epilepsies.
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Recurring déjà vu associated with 5-hydroxytryptophan
Kalra S1, Chancellor A2 and Zeman A3
1Department of Neurology, Newcastle General Hospital, Newcastle, UK.
2Department of Neurology, Bay of Plenty District Health Board, Tauranga, New Zealand.
3Cognitive and Behavioural Neurology Research Group, Peninsula Medical School, Mardon Centre, Exeter, UK.
Acta Neuropsychiatrica 19(5): 311–313, 2007
DOI: 10.1111/j.1601-5215.2007.00245.x
Background: Déjà vu occurs both in normal experience and as a neuropsychiatric symptom. Its pathogenesis is partially understood. We describe an iatrogenic case with implications for the neuropharmacological basis of déjà vu.
Case presentation: A 42-year-old woman received 5-hydroxytryptophan, in combination with carbidopa, as treatment for palatal tremor, on two occasions, separated by 1 week. On each occasion, she experienced intense, protracted déjà vu, lasting for several hours. We discuss her case in relation to the neuroanatomical and neuropharmacological basis of déjà vu.
Conclusion: The serotonergic system is involved in the genesis of déjà vu.
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Impaired familiarity with preserved recollection after anterior temporal-lobe resection that spares the hippocampus
Bowles B, Crupi C, Mirsattari SM, Pigott SE, Parrent AG, Pruessner JC, Yonelinas AP, Köhler S
Department of Psychology, University of Western Ontario, London, ON, Canada N6A 5C2
Proceedings of the National Academy of Science U S A 104(41): 16382-7, 2007
Epub 2007 Sep 28
Abstract
It is well established that the medial-temporal lobe (MTL) is critical for recognition memory. The MTL is known to be composed of distinct structures that are organized in a hierarchical manner. At present, it remains controversial whether lower structures in this hierarchy, such as perirhinal cortex, support memory functions that are distinct from those of higher structures, in particular the hippocampus. Perirhinal cortex has been proposed to play a specific role in the assessment of familiarity during recognition, which can be distinguished from the selective contributions of the hippocampus to the recollection of episodic detail. Some researchers have argued, however, that the distinction between familiarity and recollection cannot capture functional specialization within the MTL and have proposed single-process accounts. Evidence supporting the dual-process view comes from demonstrations that selective hippocampal damage can produce isolated recollection impairments. It is unclear, however, whether temporal-lobe lesions that spare the hippocampus can produce selective familiarity impairments. Without this demonstration, single-process accounts cannot be ruled out. We examined recognition memory in NB, an individual who underwent surgical resection of left anterior temporal-lobe structures for treatment of intractable epilepsy. Her resection included a large portion of perirhinal cortex but spared the hippocampus. The results of four experiments based on three different experimental procedures (remember-know paradigm, receiver operating characteristics, and response-deadline procedure) indicate that NB exhibits impaired familiarity with preserved recollection. The present findings thus provide a crucial missing piece of support for functional specialization in the MTL.
(Déjà vu mentioned on page 16383.)
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Absence of mutations in the LGI1 receptor ADAM22 gene in autosomal dominant lateral temporal epilepsy
Chabrol E1, Gourfinkel-An I, Scheffer IE, Picard F, Couarch P, Berkovic SF, McMahon JM,
Bajaj N, Mota-Vieira L, Mota R, Trouillard O, Depienne C, Baulac M, LeGuern E, Baulacemail S
1 INSERM U679, Neurology and Experimental Therapeutics, Hôpital de la Pitié-Salpêtrière, 47 boulevard de l'hôpital, 75013 Paris, France.
Epilepsy Research 76(1): 41–48, 2007
DOI: http://dx.doi.org/10.1016/j.eplepsyres.2007.06.014
Summary
Mutations in the LGI1 (leucine-rich, glioma inactivated 1) gene are found in less than a half of the families with autosomal dominant lateral temporal epilepsy (ADLTE), suggesting that ADLTE is a genetically heterogeneous disorder. Recently, it was shown that LGI1 is released by neurons and becomes part of a protein complex at the neuronal postsynaptic density where it is implicated in the regulation of glutamate-AMPA neurotransmission. Within this complex, LGI1 binds selectively to a neuronal specific membrane protein, ADAM22 (a disintegrin and metalloprotease). Since ADAM22 serves as a neuronal receptor for LGI1, the ADAM22 gene was considered a good candidate gene for ADLTE.
We have therefore sequenced all coding exons and exon–intron flanking sites in the ADAM22 gene in the probands of 18 ADLTE families negative for LGI1 mutations. Although, we identified several synonymous and non-synonymous polymorphisms, we failed to identify disease-causing mutations, indicating that ADAM22 gene is probably not a major gene for this epilepsy syndrome.
From the paper:
" AUS10: III-6 (F/30), None, 21, PS, SGTC, Auditory, None, N (interictal), Rare sz on CBZ, Déjà vu, gustatory (II-5). ... was most often associated with other ictal symptoms during the same seizure or in different seizures in the same patient (10/14): dysmnestic phenomena, aphasia, visual ..."
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The dreamy state: hallucinations of autobiographic memory evoked by temporal lobe stimulations and seizures
Vignal J-P [1], Maillard L [2], McGonigal A [3], Chauvel P [3]
1 Service de Neurologie, Hôpital Central, CHU de Nancy Nancy
2 Faculté de Medecine, Université Nancy Nancy
3 Laboratoire de Neurophysiologie et Neuropsychologie-U751, INSERM Marseille, Université de la Méditerranée Marseille Cedex, France
Correspondence to: Dr Jean-Pierre Vignal, Service de Neurologie, Hopital Central, C.O. n 34, 54035 Nancy Cedex, France. E-mail: jp.vignal a chu-nancy.fr
Brain 130(Pt 1): 88-99, 2007
Epub 2006 Nov 30
Abstract
Using results from cortical stimulations, as well as the symptoms of spontaneous epileptic seizures recorded by stereoelectroencephalography we re-studied the phenomenon of the dreamy state, as described by Jackson (Jackson JH. Selected writings of John Hughlins Jackson. Vol 1. On epilepsy and epileptiform convulsions. Taylor J, editor. London: Hodder and Stoughton; 1931). A total of 15 sensations of déjà vécu, 35 visual hallucinations consisting of the image of a scene and 5 ‘feelings of strangeness’ occurred. These were recorded during 40 stimulations in 16 subjects, and 15 seizures in 5 subjects. Forty-five per cent of dreamy states were evoked by stimulation of the amygdala, 37.5% by the hippocampus and 17.5% by the para-hippocampal gyrus. During both spontaneous and provoked dreamy state, the electrical discharge was localized within mesial temporal lobe structures, without involvement of the temporal neocortex. Early spread of the discharge to the temporal neocortex appeared to prevent the occurrence of the dreamy state. Semiological analysis showed a clinical continuity between déjà vécu and visual hallucinations, the latter often consisting of a personal memory that was ‘relived’ by the subject; such memories could be recent, distant or from childhood. With one exception, the particular memory evoked differed from one seizure to another, but were always drawn from the same period of the subject's life. Given the role of the amygdala and hippocampus in autobiographic memory, their pathological activation during seizures may trigger memory recall. This study of the dreamy state is in keeping with other evidence demonstrating the constant and central role of the amygdala and hippocampus (right as much as left) in the recall of recent and distant memories. It demonstrates the existence of large neural networks that produce recall of memories via activation of the hippocampus, amygdala and rhinal cortex.
Key Words: dreamy state; autobiographic memory; amygdala; hippocampus; cortical stimulation
Abbreviations: MTL: mesial temporal lobe; SEEG: stereoelectroencephalography
(Available online at http://brain.oxfordjournals.org/cgi/content/abstract/130/1/88)
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[Epilepsy and psychic seizures]
[in Japanese]
Fukao K
Seishin Shinkeigaku Zasshi 108(3): 240-5, 2006
Abstract
Various psychic symptoms as ictal manifestation have been found in epileptic patients. They are classified as psychic seizures within simple partial seizures, and subclassified into affective, cognitive, dysmnesic seizures and so on, although the subclassification is not yet satisfactory and almost nothing is known about their relationships with normal brain functions. In this presentation, the speaker picked ictal fear, déjà vu and out-of-body experience (OBE) from them and suggested that studies on these symptoms could uniquely contribute to the progress of cognitive neuroscience, presenting some results from the research and case study that he had been engaged in. Psychic seizures are prone to be missed or misdiagnosed unless psychiatrists with sufficient knowledge and experience on epilepsy care would not treat them, because they are subjective symptoms that are diverse and subtle, while they have some characteristics as ictal symptoms.
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[Kumagusu Minakata with temporal lobe epilepsy: a pathographic study]
[in Japanese]
Sengoku A
Clinic Sengoku
Seishin Shinkeigaku Zasshi 108(2): 132-9, 2006
Abstract
Kumagusu Minakata (1867-1941), a Japanese genius devoted to natural history and folklore, is famous for his immense range of works (including 50 monographs in 'Nature') and his discovery of several varieties of mycetozoa. His diary and the observations of other persons reveal that he was affected by several grand mal epileptic seizures, and he complained himself of frequent déjà vu experiences which he called promnesia according to Myers. Promnesia means, for example, "I have lived through all this before, and I know what will happen this next minute." Minakata also had this rare type of aural sign. MRI analysis of his postmortem brain found evidence of right hippocampal atrophy. This result showed that he had temporal lobe epilepsy with focus of the right side, and this coincides with his déjà vu experiences which were the aura of the loss of consciousness. However, he did not notice that these were aural signs, and he also complained of memory disturbances due to frequent déjà vu. His behavioral characteristics were peculiar, and those of Dostoyevsky who also had temporal lobe epilepsy were similar. Temporal lobe epilepsies may influence behavioral patterns which control the emotions. As a positive point, some patients with temporal lobe epilepsy can exhibit their primordial mental actions and perform persistent works.
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A Complex Presentation of Complex Partial Seizures
Roffman JL, Stern TA
Corresponding author and reprints: Joshua L. Roffman, M.D., Psychiatric Neuroscience Program, MGH-East, Bldg 149, 13th St., 2nd Floor, Charlestown, MA 02129 (E-mail: jroffman a partners.org).
The Primary Care Companion - Journal of Clinical Psychiatry 8(2): 98–100, 2006
Abstract
Have you encountered patients with affective, behavioral, and cognitive symptoms that were difficult to place in one diagnostic category? Have you suspected a diagnosis of complex partial seizures but found it difficult to establish this diagnosis with laboratory tests? Moreover, have you ever experienced difficulty distinguishing seizures from nonepileptic seizures (“pseudoseizures”)? If you have, then the following case vignette of a man admitted to the general hospital with a complex array of neuropsychiatric symptoms should provide the forum for answers to these and other questions related to psychiatric manifestations of seizures.
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Human EEG gamma oscillations in neuropsychiatric disorders
Herrmann CS, Demiralp T
Department of Psychology, Magdeburg University, Germany. E-mail: christoph.herrmann a nat.uni-magdeburg.de
Clinical Neurophysiology 116(12): 2719-33, 2005
Epub 2005 Oct 25.
Abstract
Due to their small amplitude, the importance of high-frequency EEG oscillations with respect to cognitive functions and disorders is often underestimated as compared to slower oscillations. This article reviews the literature on the alterations of gamma oscillations (about 30-80 Hz) during the course of neuropsychiatric disorders and relates them to a model for the functional role of these oscillations for memory matching. The synchronous firing of neurons in the gamma-band has been proposed to bind multiple features of an object, which are coded in a distributed manner in the brain, and is modulated by cognitive processes such as attention and memory. In certain neuropsychiatric disorders the gamma activity shows significant changes. In schizophrenic patients, negative symptoms correlate with a decrease of gamma responses, whereas a significant increase in gamma amplitudes is observed during positive symptoms such as hallucinations. A reduction is also observed in Alzheimer's Disease (AD), whereas an increase is found in epileptic patients, probably reflecting both cortical excitation and perceptual distortions such as déjà vu phenomena frequently observed in epilepsy. ADHD patients also exhibit increased gamma amplitudes. A hypothesis of a gamma axis of these disorders mainly based on the significance of gamma oscillations for memory matching is formulated.
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Familial temporal lobe epilepsy as a presenting feature of choreoacanthocytosis
Al-Asmi A, Jansen AC, Badhwar A, Dubeau F, Tampieri D, Shustik C, Mercho S, Savard G, Dobson-Stone C, Monaco AP, Andermann F, Andermann E
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
Epilepsia 46(8): 1256-63, 2005
Abstract
PURPOSE:
Choreoacanthocytosis (ChAc) is an autosomal recessive disorder caused by mutations in VPS13A on chromosome 9q21 and characterized by neurodegeneration and red cell acanthocytosis. Seizures are not uncommon in ChAc but have not been well characterized in the literature. We report two ChAc families in which patients presented with temporal lobe epilepsy.
METHODS:
Detailed medical and family histories were obtained. EEG, video-telemetry, brain magnetic resonance imaging (MRI) with volumetric studies of amygdala and hippocampus, as well as neuropsychological testing were performed. Blood smears were examined for acanthocytosis. Mutation analysis of VPS13A was carried out in five patients.
RESULTS:
Six patients in three sibships were initially seen with seizures. Age at seizure onset ranged from 22 to 38 years. Seizures preceded other clinical manifestations of ChAc by < or = 15 years. The epileptic aura consisted of a sensation of déjà-vu, fear, hallucinations, palpitations, or vertigo. EEG with video-telemetry showed epileptiform discharges originating either from one or both temporal lobes. Epilepsy was generally well controlled, but some patients had periods of increased seizure frequency requiring treatment with multiple antiepileptic drugs (AEDs). Both families shared a deletion of exons 70-73 of VPS13A, extending to exons 6-7 of GNA14.
CONCLUSIONS:
Temporal lobe epilepsy may be the presenting feature of ChAc and may delay its diagnosis. Epilepsy in ChAc patients represents a challenge, because seizures may at times be difficult to control, and some AEDs may worsen the involuntary movements. Mutations in VPS13A or GNA14 or both may be associated with clinical features of temporal lobe epilepsy.
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Déjà Vu and Jamais Vu as Ictal Symptoms: Qualitative Comparison with Those Occurring in Normal Subjects Using a Questionnaire
Fukao K1, Murai T1, Yamada M2, Sengoku A3 and Kusumi T4
1 Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University
2 Graduate School of Human and Environmental Studies, Kyoto University
3 Sengoku Clinic, Kyoto, Japan
4 Graduate School of Education, Kyoto University, Kyoto, Japan
Epilepsia 46: 28–29, 2005
doi: 10.1111/j.0013-9580.2005.463002_10.x
Abstract
Purpose: To clarify the similarities and differences of déjà vu and jamais vu as ictal symptoms and as an experience of normal subjects, the characteristics of ictal and normal déjà vu and jamais vu were examined by means of a questionnaire.
Methods: We examined 16 epilepsy patients having déjà vu or jamais vu as ictal symptoms and 115 healthy university students as normal controls. The diagnosis was temporal lobe epilepsy (TLE) in 15 patients and frontal lobe epilepsy (FLE) in the remaining one patient. The focus was on the right hemisphere in 10 TLE patients and the FLE patient, and on the left in the remaining 5 TLE patients. The patients were nine females and seven males were aged between 15 and 56 years. The questionnaire was on déjà vu and jamais vu of person and place, and contained items including the occurrence, contents, frequency, duration, psychological conditions related to the phenomenon, and emotions evoked by the phenomenon.
Results: Approximately 75% of normal students experienced déjà vu whereas 25% experienced jamais vu. Of the 16 patients, 8 patients had ictal déjà vu only, and 8 patients had both ictal jamais vu and déjà vu. The occurrence of déjà vu of place in the normal students was 2.5 times as high as that of déjà vu of person, and was almost the same as that found in ictal déjà vuin the patients. The most common duration of déjà vu and jamais vu was in the order of several seconds to tens of seconds in both the normal and patient groups. While normal déjà vu and jamais vu frequently evoked surprise in the normal subjects, ictal events did not evoke surprise in the patients. The most commonly evoked emotion by déjà vu, other than surprise, was nostalgia in both normal and ictal situations, and fear was evoked by jamais vu in both cases. While normal jamais vutended to occur in a condition of bodily or mental fatigue, ictal jamais vu occurred in a relaxed condition, as did ictal déjà vu. Déjà vu of place occurred more often in unfamiliar places with somehow typical scenes like sight-seeing spots among the normal subjects, whereas it occurred in familiar places such as at home among the patients. Déjà vu of person tended to occur at the first meeting with a stranger in normal subjects, while it occurred regardless of the degree of familiarity with the person in the patients. In summary, while some common characteristics were found between normal and ictal déjà vu and jamais vu, which are compatible with the mechanism of false recognition in the case of déjà vu, some differences were also detected in this study. Although some of the differences can be explained by the nonspecific characteristics of ictal phenomena presumably shared by both ictal déjà vu and jamais vu, some characteristics remain unexplained.
Conclusion: Characteristics of déjà vu as an ictal symptom cannot be sufficiently explained by the mechanism of false recognition that applies to déjà vu experienced by normal subjects, and some other factors may be involved. Ictal jamais vu also is different from normal jamais vu in some characteristics.
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Deja vu in neurology
Wild E
Dept. of Neurology, Wellington Hospital, Wellington, New Zealand. E-mail: ejwild a doctors.org.uk
Journal of Neurology 252(1): 1-7, 2005
Abstract
The significance of deja vu is widely recognised in the context of temporal lobe epilepsy, and enquiry about deja vu is frequently made in the clinical assessment of patients with possible epilepsy. Deja vu has also been associated with several psychiatric disorders. The historical context of current understanding of deja vu is discussed. The literature reveals deja vu to be a common phenomenon consistent with normality. Several authors have suggested the existence of a "pathological" form of deja vu that differs, qualitatively or quantitatively, from "non-pathological" deja vu. The features of deja vu suggesting neurological or psychiatric pathology are discussed. Several neuroanatomical and psychological models of the deja vu experience are highlighted, implicating the perceptual, mnemonic and affective regions of the lateral temporal cortex, hippocampus and amygdala in the genesis of deja vu. A possible genetic basis for a neurochemical model of deja vu is discussed. Clinical approaches to the patient presenting with possible deja vu are proposed.
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Prescience as an aura of temporal lobe epilepsy
Sadler RM, Rahey S
QEII Health Sciences Centre, Halifax, Nova Scotia, Canada. E-mail: rsadler a dal.ca
Epilepsia 45(8): 982-4, 2004
Abstract
PURPOSE: A patient with a distinct aura of prescience as a manifestation of temporal lobe epilepsy was encountered. The experience prompted a review of this ictal phenomenon among patients attending a tertiary care epilepsy outpatient clinic.
METHODS: A computer epilepsy database was searched for patients with simple partial sensory seizures and complex partial seizures with auras. Identified patients had charts reviewed for details of the auras; patients were contacted and asked to provide written descriptions of their experiences. Literature searches (PubMed) were done by using the terms "precognition" or "prescience" and "seizures" or "epilepsy." Standard comprehensive epilepsy textbooks were reviewed.
RESULTS: The charts of 218 patients were reviewed from 927 in the database; three had prescience as an ictal feature. The patients' descriptions were very similar in all cases (a profound sense of "knowing" what was going to happen in their environment in the immediate future). The experience was distinct from déjà vu and other psychic experiences. All patients probably have temporal lobe epilepsy. Only one other description of prescience as an ictal feature was found in the literature.
CONCLUSIONS: Prescience can occur as an ictal feature of temporal lobe epilepsy and represents a previously underreported psychic phenomenon. The potential lateralizing value of this symptom is yet to be determined.
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Cortical stimulation study of the role of rhinal cortex in déjà vu and reminiscence of memories
Bartolomei F, Barbeau E, Gavaret M, Guye M, McGonigal A, Régis J and Chauvel P
Service de Neurophysiologie Clinique et Epileptologie, INSERM EMI-U 9926, CHU TIMONE et Université de la Méditerranée, Marseille Cedex 5, France.
Address correspondence and reprint requests to Dr. Fabrice Bartolomei, Service de Neurophysiologie Clinique, CHU Timone-264 Rue st Pierre, 13005-Marseille, France. E-mail: fbartolo a medecine.univ-mrs.fr
Neurology 63: 858-864, 2004
Abstract
Objective: To study the role of perirhinal (PC) and entorhinal cortices (EC) in dreamy state symptoms (déjà vu and reminiscence of scenes). These phenomena have been attributed to functional alteration of memory networks supported by the medial temporal lobes, principally involving the amygdala and hippocampus. The role of sub-hippocampal structures (EC and PC) in inducing these phenomena has not previously been addressed.
Methods: The authors studied the symptoms evoked by direct electrical stimulations of PC and EC in comparison with those obtained after stimulation of the amygdala and hippocampus. Stimulations were performed in a group of 24 patients with epilepsy, during stereoelectroencephalographic (SEEG) recordings in the setting of presurgical evaluation. All patients had electrodes that sampled the rhinal cortices, amygdala, and hippocampus.
Results: A total of 280 stimulations were analyzed. Entorhinal and perirhinal stimulations induced classic mesial temporal lobe responses (emotional, dysautonomic) but also more specific responses, particularly the déjà vuphenomenon and reminiscence of scenes. Such déjà vu or déjà vécu type responses were produced proportionately more often by stimulation of the EC than by stimulation of the amygdala and hippocampus. In particular, déjà vu was associated with stimulation of the EC and reminiscence of memories with PC stimulation.
Conclusion: This study strongly suggests that experiential symptoms are largely dependent upon functional modification of the physiology of the rhinal cortices.
(Available online at http://n.neurology.org/content/63/5/858.long)
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Magnetic resonance imaging abnormalities in familial temporal lobe epilepsy with auditory auras
Kobayashi E, Santos NF, Torres FR, Secolin R, Sardinha LA, Lopez-Cendes I, Cendes F
Department of Neurology, Campinas State University, Campinas, Brazil
Archives of Neurology 60(11): 1546-51, 2003
(Erratum in Archives of Neurology 61(2): 199, 2004)
Abstract
BACKGROUND:
Two forms of familial temporal lobe epilepsy (FTLE) have been described: mesial FTLE and FTLE with auditory auras. The gene responsible for mesial FTLE has not been mapped yet, whereas mutations in the LGI1 (leucine-rich, glioma-inactivated 1) gene, localized on chromosome 10q, have been found in FTLE with auditory auras.
OBJECTIVE:
To describe magnetic resonance imaging (MRI) findings in patients with FTLE with auditory auras.
DESIGN AND METHODS:
We performed detailed clinical and molecular studies as well as MRI evaluation (including volumetry) in all available individuals from one family, segregating FTLE from auditory auras.
RESULTS:
We evaluated 18 of 23 possibly affected individuals, and 13 patients reported auditory auras. In one patient, auditory auras were associated with déjà vu; in one patient, with ictal aphasia; and in 2 patients, with visual misperception. Most patients were not taking medication at the time, although all of them reported sporadic auras. Two-point lod scores were positive for 7 genotyped markers on chromosome 10q, and a Zmax of 6.35 was achieved with marker D10S185 at a recombination fraction of 0.0. Nucleotide sequence analysis of the LGI1 gene showed a point mutation, VIIIS7(-2)A-G, in all affected individuals. Magnetic resonance imaging was performed in 22 individuals (7 asymptomatic, 4 of them carriers of the affected haplotype on chromosome 10q and the VIIIS7[-2]A-G mutation). Lateral temporal lobe malformations were identified by visual analysis in 10 individuals, 2 of them with global enlargement demonstrated by volumetry. Mildly reduced hippocampi were observed in 4 individuals.
CONCLUSIONS:
In this family with FTLE with auditory auras, we found developmental abnormalities in the lateral cortex of the temporal lobes in 53% of the affected individuals. In contrast with mesial FTLE, none of the affected individuals had MRI evidence of hippocampal sclerosis.
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Exacerbation of mania secondary to right temporal lobe astrocytoma in a bipolar patient previously stabilized on valproate
Sokolski KN, Denson TF
VA Long Beach Healthcare System, Mental Health Care Group, Long Beach, California 90822, USA. E-mail: kenneth.sokolski a med.va.gov
Cognitive and Behavioral Neurology 16(4): 234-8, 2003
Abstract
OBJECTIVES:
To investigate breakthrough mania secondary to a right temporal lobe neoplasm in a bipolar patient previously stabilized on sodium divalproex.
BACKGROUND:
Right hemispheric brain tumors involving the orbitofrontal or basotemporal cortex are a rare cause of secondary mania. In such cases, early neurologic signs may be difficult to distinguish from bipolar symptoms. Breakthrough mania secondary to brain neoplasm in a bipolar patient stabilized on medication is an extremely rare phenomena which has not been previously reported.
METHOD:
The clinical course of a bipolar subject stabilized on valproate who developed mania secondary to a right temporal lobe astrocytoma is described. Serial brain magnetic resonance imaging (MRI), baseline electroencephalogram (EEG), and neuropsychiatric evaluations were used to examine the relationship between the patient's brain mass and behavioral disturbances.
RESULTS:
Symptoms were those that accompanied prior episodes of mania. In addition, signs of temporal lobe dysfunction were evident including periods of detachment, déjà vu experiences, and olfactory hallucinations. In the context of mania, depersonalization was initially attributed to bipolar symptoms. Only several months later, when olfactory hallucinations and alterations in consciousness became evident, was a temporal lobe lesion suspected. Neuropsychiatric abnormalities responded to a combination of surgical intervention, radiation therapy, and topiramate, however the tumor was advanced and invasive at diagnosis resulting in a poor prognosis.
CONCLUSIONS:
This case suggests that clinicians examining unexplained cases of breakthrough mania should be vigilant for early signs of temporal lobe dysfunction, which could aid in detecting treatable lesions.
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Tales from the temporal lobes
Zeman A
New England Journal of Medicine 352(2): 119-121, 2003
(The author provided descriptions of the effects of temporal lobe epilepsy, including déjà vu. At the end of his paper he wrote: "Déjà vu, short-lived amnesia, the epigastric aura, hallucinations of smell, incongruous emotions, disorders of language, and out-of-body experiences can all be pointers to a disturbance of function in the temporal lobes. The elegance of clinical neurology lies in the possibility of localizing pathologic lesions in the brain on the basis of clinical features such as these, which may consist of a single minor perturbation of experience. But location does not imply process. Don't rush to diagnose epilepsy the next time you experience déjà vu. The range of possible explanations bridges the divide between neurology and psychiatry: anxiety, depression, and psychosis are important causes, as is the likeliest candidate of all — that your perfectly normal but hard-pressed temporal lobes are temporarily overstretched." p. 121)
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Paramnesic multiplication of autobiographical memory as a manifestation of interictal psychosis
Murai T, Fukao K
Department of Psychiatry, Faculty of Medicine, Kyoto University, Kyoto, Japan. E-mail: murai a kuhp.kyoto-u.ac.jp
Psychopathology 36(1): 49-51, 2003
Abstract
This report describes a male patient with temporal lobe epilepsy who developed a persistent paranoid-hallucinatory state at the age of 23. The essential feature of his delusion was that he had repeatedly lived part of his life, namely between the ages of 21 and 25 years. The patient repeatedly attempted suicide to escape the endless repetition. His paramnesia has some similarity with a déjà vu phenomenon, which is a common ictal manifestation of temporal lobe epilepsy. However, while only a sense of vague familiarity is evoked in a déjà vuphenomenon, conscious recollection is experienced during his paramnesia. We attempted to explain the pathophysiological mechanism of the patient's paramnesia in the framework of the current neurobiological theory of human memory.
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Ictal SPECT in a case of pure musicogenic epilepsy
Gelisse P, Thomas P, Padovani R, Hassan-Sebbag N, Pasquier J, Genton P
Centre Saint-Paul, Marseille, France
Epileptic Disorders 5(3): 133-7, 2003
Abstract
A 39-year-old, right-handed woman had seizures for two years which were always triggered by exposure to various types of music: the first occurred while she listened to a tune she particularly liked, Con Te Partiro, by Andrea Boccelli. Other triggering factors were various types of music such as supermarket background music and polyphonic singing or instrumental music played by family members. The seizures had a stereotyped course: she felt anxious, tearful, then occurred slight obtundation, during which she smacked her lips and moved restlessly. There was no complete loss of consciousness, but some degree of amnesia. She never experienced a generalized tonic-clonic seizure, but reported rare spontaneous feelings of déjà-vu that had begun at the same time as the induced seizures. There were no other spontaneous attacks; only one seizure was apparently provoked, not by music but by a loud background noise in her office. She was a music lover and a singer. Interictal EEG showed independent slow waves over the temporal regions. Several seizures with EEG localisation over the right temporal region were elicited after several minutes of exposure to music. Monoauricular stimulation with the same music produced a seizure when applied to the left ear but was ineffective when applied to the right ear. Ictal SPECT demonstrated right temporal hyperperfusion. MRI was normal. On high dose of carbamazepine, seizure frequency decreased. The addition of topiramate resulted in full seizure control. Musicogenic epilepsy is a rare form of reflex epilepsy. Pure cases, when patients do not experience unprovoked seizures, are exceptional. Our report confirms the implication of the right temporal lobe in this epilepsy.
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The persistence of erroneous familiarity in an epileptic male: Challenging perceptual theories of déjà vuactivation
O’Connor AR [1], Moulin CJA [2]
1 Department of Psychology, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
2 Institute of Psychological Sciences, University of Leeds, Leeds, LS2 9JT, UK
Journal of Neuropsychiatry and Clinical Neurosciences 14:6-10, 2002
Abstract
We report the case of a 39-year-old, temporal lobe epileptic male, MH. Prior to complex partial seizure, experienced up to three times a day, MH often experiences an aura experienced as a persistent sensation of déjà vu. Data-driven theories of déjà vu formation suggest that partial familiarity for the perceived stimulus is responsible for the sensation. Consequently, diverting attention away from this stimulus should cause the sensation to dissipate. MH, whose sensations of déjà vu persist long enough for him to shift his perceptual focus a number of times during the experience, spontaneously reports that these shifts make no difference to the sensation experienced. This novel observation challenges data-driven theories of déjà vu formation which have been used to explain the occurrence of déjà vu in those with temporal lobe epilepsy and the general population. Clearly, in epilepsy, erratic neuronal firing is the likely contributor, and in this paper we postulate that such brain firing causes higher-order erroneous ‘cognitive feelings’. We tentatively extend this account to the general population. Rather than being a reaction to familiar elements in perceptual stimuli, déjà vu is likely to be the result of a cognitive feeling borne of the erroneous activation of neural familiarity circuits such as the parahippocampal gyrus, persisting as long as this activation persists.
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Déjà Vu: Possible Parahippocampal Mechanisms
Spatt J
Ludwig Boltzmann Institute for Epilepsy and Neuromuscular Disorders, Rosenhügel Neurological Hospital, Vienna, Austria.
Address correspondence to Dr. Spatt, II. Neurologische Abteilung, Neurologisches Krankenhaus Rosenhügel, Riedelgasse 5, 1130 Vienna, Austria. E-mail: josef.spatt a chello.at.
Journal of Neuropsychiatry and Clinical Neurosciences 14: 6-10, 2002
Abstract
Déjà vu experiences are common in normal subjects. In addition, they are established symptoms of temporal lobe seizures. The author argues that the phenomenon is the result of faulty and isolated activity of a recognition memory system that consists of the parahippocampal gyrus and its neocortical connections. This memory system is responsible for judgments of familiarity. The result is that a momentary perceived scene is given the characteristics of familiarity that normally accompany a conscious recollection. The normal functioning of other brain structures involved in memory retrieval - the prefrontal cortex and the hippocampus proper - leads to the perplexing phenomenological quality of déjà vu. The hypothesis accounts for many characteristics of déjà vu in healthy subjects and is well fitting with experimental findings in patients with epilepsy.
Key Words: Memory - Déjà Vu - Parahippocampal Cortex
(Available online at https://neuro.psychiatryonline.org/doi/pdf/10.1176/jnp.14.1.6)
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A 4-Year-Old Boy with Partial Complex Seizures
Di Rocco C, Jallo G I, Silvera M, Jimenez E, Abbott, IR
Pediatric Neurosurgery 34(6): 319-324, 2001
http://search.proquest.com/docview/290623628?accountid=14616
Abstract
This is a 4-year-old boy who presented to a neurologist with staring episodes at preschool, automatism and deja vu feelings for a period of 3 months. These events were increasing in frequency, thus he was started on Tegretol. He then had a grand mal seizure which prompted a diagnostic imaging study. A magnetic resonance imaging scan (MRI) was obtained which revealed the lesion. He was then referred to the Institute for Neurology and Neurosurgery for further management. He has no known drug allergies. His admission medications were only Tegretol (100mg twice a day).
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The Amygdala and Temporal Lobe Simple Partial Seizures: A Prospective and Quantitative MRI Study
Van Paesschen W1, King MD, Duncan JS and Connelly A
1 Epilepsy Research Group, National Society for Epilepsy, Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, England. Win.Vanpaesschen a uz.kuleuven.ac.be
Epilepsia 42: 857–862, 2001
doi: 10.1046/j.1528-1157.2001.042007857.x
Summary
Purpose: To determine whether specific temporal lobe simple partial seizures (SPSs) are associated with an abnormal amygdala T2 (AT2) ipsilateral to the seizure focus in patients with intractable unilateral temporal lobe epilepsy (TLE). AT2 relaxation time mapping is a sensitive method for the detection of abnormal tissue in the amygdala in patients with refractory TLE. The relation between an abnormal AT2 in the epileptic temporal lobe and amygdala seizure onset has not been established.
Methods: Fifty patients with intractable unilateral TLE and concordant data during presurgical evaluation were included. Patients with a foreign-tissue lesion on standard magnetic resonance imaging (MRI) were excluded. All had AT2 mapping. Fifteen types of SPSs were ascertained prospectively, systematically, and blinded to the results of AT2 mapping. The SPSs of patients with a normal AT2 (n = 25) were compared with those of patients with an abnormal AT2 ipsilateral to the seizure focus (n = 25).
Results: The group of patients with an abnormal AT2 reported a median of six types of SPSs (range 1–11), in comparison with a median of three types of SPSs (range, 0–7) for the group with a normal AT2 (p<0.01). Déjà vu, a warm sensation, an indescribable strange sensation, a cephalic sensation, and fear were associated with an abnormal AT2. The combination of déjà vu, a cephalic sensation, a warm sensation, a gustatory hallucination, and an indescribable strange sensation discriminated best between the 25 patients with a normal and the 25 patients with an abnormal AT2.
Conclusions: A high number and the types of different SPSs provide clinical evidence for early involvement of the amygdala during seizures in patients with refractory unilateral TLE and an abnormal AT2 in the epileptic temporal lobe.
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A case of temporal lobe epilepsy with improvement of clinical symptoms and single photon emission computed tomography findings after treatment with clonazepam
Ide M, Mizukami K, Suzuki T, Shiraishi H
Division of Psychiatry, University of Tsukuba Hospital, Ibaraki, Japan
The Journal of Neuropsychiatry & Clinical Neurosciences 54(5): 595-7, 2000
Abstract
A 26-year-old female presented psychomotor seizures, deja vu and amnestic syndrome after meningitis at the age of 14 years. Repeated electroencephalograms (EEG) demonstrated occasional spikes localized in the right temporal region in addition to a considerable amount of theta waves mainly in the right fronto-temporal region. Single photon emission computed tomography (SPECT) showed a marked hypoperfusion corresponding to the region in which the EEG showed abnormal findings, although magnetic resonance imaging (MRI) demonstrated no abnormal findings associated with the clinical features. Treatment with clonazepam in addition to sodium valproate resulted in a remarkable improvement of clinical symptoms (i.e. psychomotor seizures and deja vu), as well as of the EEG and SPECT findings. The present study suggests that SPECT is a useful method not only to determine the localization of regions associated with temporal lobe epilepsy but also to evaluate the effect of treatment in temporal lobe epilepsy.
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Ictal “Doppelganger” Experience
Hara S, Takei S, Yokoyama N and Hara T
Epilepsia 41: 65, 2000
doi: 10.1111/j.1528-1157.2000.tb02258.x
Abstract
Purpose: To believe in another self (“Doppelganger” experience) connotes either a sensation of another self being nearby (“leibhaftige Bewussstsein” type) or autoscopy. Such experiences can occur as a component of a simple partial seizure with psychic symptomatology. Ictal autoscopies are divided into (1) seeing another self as if in a familiar scene in the past (scene type): and (2) seeing another self as if in a mirror (mirror type). We here summarize features of patients with the ictal “Doppelganger” experience.
Method: Thirteen right-handed people with epilepsy with the ictal “Doppelganger” experience (3 men and 10 women: mean age, 42.5 years: range, 22–57 years) were studied.
Results: In any given seizure, “Doppelganger” experiences were preceded by 1 or more of subjective components, which, as depicted below, are listed in order of appearance and are linked by arrows: déjà vu -> depersonalization 4 “Doppelganger” of “leibhaftige Bewusstsein” type (1 case), déjà vu depersonalization “Doppelganger” of “leibhaftige Bewusstsein” type -> autoscopy of scene type (2 cases), déjà vu -> depersonalization ->“Doppelganger” of “leibhaftige Bewusstsein” type déjà autoscopy of mirror type (2 cases), déjà vu -> depersoialization -> autoscopy of scene type (2 cases), déjà vu ->“Doppelganger” of “leibhaftige Bewusstsein” type autoscopy of scene type (2 cases), déjà vu autoscopy of scene type (Icase), depersonalization 4 “Doppelganger” of “leibhaftige Bewusstsein” type (1 case), depersonalization ->“Doppelganger” of “leibhaftige Bewusstsein” type -> autoscopy of mirror type (Icase), elementary visual hallucination, visual illusion -> autoscopy of mirror type (2 cases). The interictal EEG showed temporal spike foci in 7 cases with autoscopy of scene type and 2 cases with no seizure evolution further than “Doppelganger” of “leibhaftige Bewusstsein” type. Three of 4 cases of patients with seizures and the autoscopy of mirror type showed parietooccipital spike foci. Of 13 cases, the seizure focus was left in 6, right in 6, and bilateral in 1. SPECT imaging revealed regions of hypoperfusion, usually correlated to regions of EEG spiking.
Conclusion: Ictal Doppelganger experiences include features of déjà VLI depersonalization Doppelganger of leibhaftige Bewusstsein and autoscopy. SPECT imaging and interictal EEG demonstrate that the autoscopy of scene type is associated with temporal lobe foci, while autoscopy of mirror type usually is associated with parieto-occipital foci. Laterality bore no relevance to the ictal “Doppelganger” experience.
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Absence of simple partial seizure in temporal lobe epilepsy: its diagnostic and prognostic significance.
Inoue Y1, Mihara T, Matsuda K, Tottori T, Otsubo T, Yagi K.
Author information
1 National Epilepsy Center, Shizuoka Higashi Hospital, Japan.
Epilepsy Research 38(2-3): 133-138, 2000
PMID: 10642041
Abstract
The diagnostic and prognostic significance of the absence of simple partial seizures (SPS) immediately preceding complex partial seizures (CPS) was examined in patients with temporal lobe epilepsy. The status of self-reported SPS in 193 patients with temporal lobe epilepsy who had surgical therapy more than 2 years ago was reviewed. Before surgery, 37 patients never experienced SPS before CPS (Group A), 156 patients either always or occasionally had SPS before CPS (Group B). The frequency of mesial temporal sclerosis (MTS) was lower and the age at onset of epilepsy was higher in Group A. The seizure focus was in the language-dominant temporal lobe in 73% of the cases in Group A, compared with 40% in Group B. The surgical outcome did not differ between the two groups. The findings suggest that temporal lobe seizures without preceding SPS tend to originate in the language-dominant temporal lobe that contains a pathologic etiology other than MTS, especially in the lateral temporal lobe. The surgical outcome in patients without SPS is similar to that in patients with SPS.
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Photogenic partial seizures
Hennessy MJ, Binnie CD
Department of Clinical Neurophysiology, Kings College Hospital, London, England, UK
Epilepsia 41(1): 59-64, 2000
Abstract
PURPOSE:
To establish the incidence and symptoms of partial seizures in a cohort of patients investigated on account of known sensitivity to intermittent photic stimulation and/or precipitation of seizures by environmental visual stimuli such as television (TV) screens or computer monitors.
METHODS:
We report 43 consecutive patients with epilepsy, who had exhibited a significant EEG photoparoxysmal response or who had seizures precipitated by environmental visual stimuli and underwent detailed assessment of their photosensitivity in the EEG laboratory, during which all were questioned concerning their ictal symptoms.
RESULTS:
All patients were considered on clinical grounds to have an idiopathic epilepsy syndrome. Twenty-eight (65%) patients reported visually precipitated attacks occurring initially with maintained consciousness, in some instances evolving to a period of confusion or to a secondarily generalized seizure. Visual symptoms were most commonly reported and included positive symptoms such as coloured circles or spots, but also blindness and subjective symptoms such as "eyes going funny." Other symptoms described included nonspecific cephalic sensations, deja-vu, auditory hallucinations, nausea, and vomiting. No patient reported any clear spontaneous partial seizures, and there were no grounds for supposing that any had partial epilepsy excepting the ictal phenomenology of some or all of the visually induced attacks.
CONCLUSIONS:
These findings provide clinical support for the physiological studies that indicate that the trigger mechanism for human photosensitivity involves binocularly innervated cells located in the visual cortex. Thus the visual cortex is the seat of the primary epileptogenic process, and the photically triggered discharges and seizures may be regarded as partial with secondary generalization.
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[Non-convulsive paroxysmal disorders in exogenous-organic diseases of the brain]
[in Russian]
Piven' BN, Koveva OP
Zhurnal Nevrologii I Psikhiatrii Imeni SS Korsakova 99(5): 11-4, 1999
Abstract
Examination of 273 patients with exogenous-organic diseases of the brain revealed nonconvulsive paroxysmal disorders of traumatic, toxic, infectious, radioactive and combined origin in 112 cases (41.0%). Such disorders were characterised by pronounced polymorphism and presented with viscero-vegetative (36.6%), affective (27.7%), psychosensory (19.6%), sensory (15.2%), ideatoric (11.6%) paroxysms as well as with twilight states of consciousness (16.1%), absence seizures (10.7%), narcolepsy (2.7%), catalepcy (1.8%) and the states of "déjà vu" and "jamais vu" (5.4%). In most of the patients such paroxysms were found 5 or more years after exogenous influences, i.e. when the severity of the organic brain damage increased. A resemblance of nonconvulsive paroxysms was observed in the patients with different etiology of the disease. The disorders were seldom detected in routine medical practice which may cause in adequate therapy.
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Interictal 18FDG PET findings in temporal lobe epilepsy with déjà vu
Adachi N, Koutroumanidis M, Elwes RD, Polkey CE, Binnie CD, Reynolds EH, Barrington SF, Maisey MN, Panayiotopoulos CP
Institute of Epileptology, Kings' College Hospital, London, UK
The Journal of Neuropsychiatry & Clinical Neurosciences 11(3): 380-6, 1999
(The authors studied the functional anatomy of the déjà vu (DV) experience in nonlesional temporal lobe epilepsy (TLE), using interictal fluorine-18 fluorodeoxyglucose PET in 14 patients with and 17 patients without DV. Several clinical conditions, such as age at PET study, side of ictal onset zone, and dominance for language, were no different between the two groups. The patients with DV showed significant relative reductions in glucose metabolism in the mesial temporal structures and the parietal cortex. The findings demonstrate that ictal DV is of no lateralizing value. They further suggest that temporal lobe dysfunction is necessary but not sufficient for the generation of DV. Extensive association cortical areas may be involved as part of the network that integrates this distinct experience.)
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[Contribution of John Hughlings Jackson to the understanding of epilepsy]
[Article in Spanish]
Balcells Riba M
Servicio de Neurología, Hospital del Sagrado Corazón, Barcelona
Neurologia 14(1): 23-8, 1999
Abstract
The figure of J. H. Jackson is one of the most relevant in the history of neurology. His longest period not only during his training but also during his professional plenitude took place in the National Hospital. Jackson was a great clinician, wrote many articles and gave a lot of lectures, but never wrote either a treatise or a monograph about his special field. He did not carry out animal experiments. He introduced in Britain the use of the ophthalmoscope in the neurological exploration and founded the journal Brain. He was specially interested in language disorders, paralysis, vertigo, mental disorders, cerebral tumours and above all epilepsy. He systematized what we today know as complex partial crisis, establishing the link between the function of the temporal lobe and the sensorial auras, automatism's, déjà-vu and jamais vu phenomena. He described the uncinate crisis, the topographic progression of the motor partial crisis and its posterior generalisation, establishing the motor pattern of cerebral cortex. The clinical observations of epileptic phenomena, with the influence of the evolutive ideas from Spencer, were the seeds for the elaboration of the evolutive development of the function of the nervous system. His theory about evolution and dissolution of the neurological functions was the starting point for Freud's clinical investigation. The Jacksonian set of ideas were experimentally proved by the neurophysiological work of Sherrington.
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Temporal lobe epilepsy in a genius of natural history: MRI volumetric study of postmortem brain
Murai T, Hanakawa T, Sengoku A, Ban T, Yoneda Y, Fujita H, Fujita N.
Department of Psychiatry, Faculty of Medicine, Kyoto University, Japan.
Neurology 50(5): 1373-6, 1998
Abstract
Kumagusu Minakata (1867-1941), a Japanese genius devoted to natural history and folklore, is famous for his immense range of works, including his discovery of many new varieties of mycetozoa, or slime molds. His diary reveals that he was affected by epilepsy. In this study of his brain, we adopted a method of measuring the volume of the hippocampi by MRI of postmortem brain and found evidence of right hippocampal atrophy. This finding, together with the striking parallels between his behavior and the known behavioral syndrome in temporal lobe epilepsy (TLE), suggests that he was affected by TLE. The postmortem imaging analysis of brain, as performed in this study, offers a bridge between neuroscience and classic psychopathologic approaches to the creativity of geniuses.
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[Diagnosis of seizures originating in the amygdala and the hippocampus]
[Article in Spanish]
Padró L, Rovira R
Servei de Neurología, Hospital General Universitari Vall d'Hebron, Barcelona, España
Revue neurologique 26(150): 261-5, 1998
Abstract
INTRODUCTION:
Lesions in the hippocampus of some epileptic patients were first described one hundred and seventy years ago. Since then our knowledge of the relationship between epileptic seizures and temporal lobe lesions has greatly improved.
DEVELOPMENT:
The aim of this paper is to systematize the symptomatology of the hippocampus and amygdala seizures. These seizures may have a great number of different clinical features: special 'loss' or 'impairment of consciousness', epileptic automatisms and autonomic changes. Moreover, at the beginning of seizures some patients have reported experiences having subjective qualities similar to those experienced in everyday life. P Gloor named them 'experiential phenomena' and subdivided them into affective (eg: fear), perceptual (eg: visual hallucinations) and mnemonic (eg: 'déjà vu' illusion).
CONCLUSION:
It is very important to know the contribution of the hippocampus and the amygdala to the symptomatology of temporal lobe seizures due to the progress of MRI diagnostic possibilities that are improving the surgical outcome.
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[Troubles psychiques et épilepsie partielle complexe]
[Psychic disorders and complex partial epilepsy] [in French]
Marcel E, Schiopu B
L'Evolution Psychiatrique 63(3): 395-408, 1998
Summary
Complex partial epilepsy is a classical neurological pathology with a varied clinical manifestation. The classical "temporal crisis" with its elements of depersonaiisation "deja vu' "jamais vu", olfactive hallucinations (uncinate fit) is not the only manifestation, by far. of this clinical form of epilepsy. The clinical polymorphism covers the range from mere "temporal absence" to the most complex psychomotor automatism in which the subject conveys the impression of being in touch with reality. of being able to answer his interlocutor's questions. In the same way the duration of these comitial fits is most variable, from a few seconds to several days. giving rise to these very rare partial complex states of a long lasting condition of which the epileptic fugues are the prototype. The clinic of this partial epilepsy is so infinitely variable that the differential diagnoses abound, above all with psychiatric pathologies, which range from the suggestion of hysteria to that of psychotic pathologies. We shall illustrate this partial complex epilepsy with a clinical case of a 40 year-old woman who on several occasions has presented partial complex states of which the most recent lasted 72 hours. The diagnosis had for a long time wandered and it was only with the third psychiatric hospitalization that it could be amended. Before that the diagnosis of recurrent "brief pseudo-psychotic periods of delusional depersonaiisation" had been pronounced. Between these 'noisy' moments the patient manifested moments of probable absence. The cognitive and mnesic after-effects were significant. Several months were needed after the instauration of an anti-epileptic treatment for the recuperation of the mnesic functions. This case illustrates with a vengeance the difficulty, clinical and para-clinical, to assert the diagnosis of epilepsy when faced with brief pseudo psychotic periods of delusional depersonalisation which look frankly psychiatric. Regarding this question we provide a reminder of the clinic, of the paraclinical examinations and their limits as well as the etiologies encountered in this condition. We also try to establish a link between the thalamic anomaly found in our patient, the physiopathology and the psychopathological expression of the disorders presented.
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Aura phenomena during syncope
Benke T, Hochleitner M, Bauer G
Neurological Department, University Clinic, Innsbruck, Austria
European Neurology 37(1): 28-32, 1997
Abstract
We studied the frequency and clinical characteristics of aura phenomena in 60 patients with cardiac and 40 subjects with vasovagal syncopes. The majority (93%) of all syncope patients recalled having experienced an aura. Aura phenomena were similar in both groups and were mostly compound auras comprising epigastric, vertiginous, visual, or somatosensory experiences, but were more detailed in the noncardiac group. The localizing significance of auras preceding a syncope was generally poor. Although hard to distinguish from epileptic auras from their structure and shape, syncope-related auras lacked symptoms that are commonly reported after epileptic seizures such as tastes, smells, déjà vu phenomena, scenic visual perceptions, and speech impairments. A detailed anamnestic exploration of auras seems worthwhile in unexplained disorders of consciousness.
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Ictal semiology in hippocampal versus extrahippocampal temporal lobe epilepsy
Gil-Nagel A, Risinger MW
Brain 120: 183-192, 1997 (c.f. pp. 185, 187)
Summary
We have analysed retrospectively the clinical features and electroencephalograms in 35 patients with complex partial seizures of temporal lobe origin who were seizure-free after epilepsy surgery. Two groups were differentiated for statistical analysis: 16 patients had hippocampal temporal lobe seizures (HTS) and 19 patients had extrahippocampal temporal lobe seizures (ETS) associated with a small tumour of the lateral or inferior temporal cortex. All patients in the HTS group had ictal onset verified with intracranial recordings (depth or subdural electrodes). In the ETS group, extrahippocampal onset was verified with intracranial recordings in eight patients and assumed, because of failure of a previous amygdalohippocampectomy, in one patient. Historical information, ictal semiology and ictal EEG of typical seizures were analysed in each patient. The occurrence of early and late oral automatisms and dystonic posturing of an upper extremity was analysed separately. A prior history of febrile convulsions was obtained in 13 HTS patients (81.3%) but in none with ETS (P < 0.0001, Fisher's exact test). An epigastric aura preceded seizures in five patients with HTS (31.3%) and none with ETS (P = 0.0135, Fisher's exact test), while an aura with experiential content was recalled by nine patients with ETS (47.4%) and none with HTS (P = 0.0015), Fisher's exact test). Early oral automatisms occurred in 11 patients with HTS (68.8%) and in two with ETS (10.5%) (P = 0.0005, Fisher's exact test). Early motor involvement of the contralateral upper extremity without oral automatisms occurred in three patients with HTS (18.8%) and in 10 with ETS (52.6%) (P = 0.0298, Fisher's exact test). Arrest reaction, vocalization, speech, facial grimace, postictal cough, late oral automatisms and late motor involvement of the contralateral arm and hand occurred with similar frequency in both groups. These observations show that the early clinical features of HTS and ETS are different.
(3 out of the 9 patients from the extrahippocampal TLE group had déjà vu experiences as part of their seizure auras (p. 187). Altogether there were 35 TLE patients, so the incidence of 3 out of 35 results in an incidence of 9% [i.e., much lower than in the general population].)
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Dreamy states and psychoses in temporal lobe epilepsy: mediating role of affect
Sengoku A, Toichi M, Murai T
Department of Psychiatry, Faculty of Medicine, Kyoto University, Japan
The Journal of Neuropsychiatry & Clinical Neurosciences 51(1): 23-6, 1997
Abstract
Among 104 patients with temporal lobe epilepsy treated in our clinic between 1992-1995, thirteen patients with repeated dreamy states were evaluated for affective manifestations of dreamy states and their relationship with psychotic states. The types of dreamy states were classified as déjà vu, jamais vu and reminiscence. The affective experiences during dreamy states were evaluated as positive, negative or neutral. As a result, seven patients had déjà vu and/or reminiscence: seizure manifestations in four of these patients were affectively evaluated as positive (familiar and/or pleasurable), and three as neutral. Six cases had experience of jamais vu: five of them were affectively evaluated as negative (mostly fear), and one as neutral. Psychiatrically, only four patients with jamias vu accompanied by feelings of fear had mental disorders: a chronic paranoid-hallucinatory state in two cases, a chronic paranoid state in one case, and obsessive-compulsive symptoms in one case. Other patients who had positive or neutral affect did not demonstrate psychiatric disturbances. Thus, most patients with jamais vu were accompanied by negative affect of fear, and those patients with jamais vu tended to show more psychotic symptoms than those with reminiscence or déjà vu, which were associated with positive or neutral affects. Based on these results, we discuss the possibility that repeated negative feelings associated with jamais vu are one of the causes for developing epileptic psychoses.
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Transient sensations of impending loss of consciousness: the "blip" syndrome
Lance JW
Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, Australia
Journal of Neurology, Neurosurgery and Psychiatry 60(4): 437-8, 1996
Abstract
Momentary sensations of impending loss of consciousness may occur, particularly when a person is relaxed, without any obvious cardiac, cerebral vascular, or epileptic basis. These episodes may be a quasiepileptic phenomenon such as déjà vu and night starts and seem to have a benign prognosis.
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Microsomatoagnosia: whole body schema illusion as part of an epileptic aura
Leker RR1, Kami A and River Y
1Department of Neurology, Hebrew University, Hadassah Medical Center, Jerusalem, Israel
Acta Neurologica Scandinavica 94(6): 383–385, 1996
DOI: 10.1111/j.1600-0404.1996.tb00049.x
Abstract
We report a patient who presented with a whole body microsomatoagnosia as part of an epileptic aura. We postulate that this rare phenomenon argues in favor of the existence of a whole body integrative neuronal network which mediates the bodily awareness.
From the paper:
"Among the more common experiential phenomena are visual and auditory hallucinations and illusions, dysphasic syndromes, dreamy states, derealization, depersonalization, dissociative states, emotional states, and dysmnestic experiences such as the deja vu phenomena ..."
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The anatomy of epileptic auras: focal pathology and surgical outcome
Fried I1, Spencer DD and Spencer SS
1Division of Neurosurgery, University of California, Los Angeles, USA.
Journal of Neurosurgery 83(1): 60-66, 1995
DOI: 10.3171/jns.1995.83.1.0060
Abstract
An aura is generally understood to be the beginning of a seizure. Yet, following successful surgery for intractable epilepsy, patients may have persistent auras even though they are otherwise seizure free. Ninety patients with intractable seizures and auras underwent resective surgery. Forty-three patients had hippocampal sclerosis and 47 had temporal or extratemporal lesions such as glial tumors or vascular malformations. The semiology of the auras was found to have value in localization but not lateralization of the pathology. Epigastric auras as well as gustatory and olfactory auras were significantly more frequent in patients with hippocampal sclerosis than in those with temporal or extratemporal lesions. Auras of vertigo or dizziness were most frequent in patients with extratemporal pathology.
There was a significant difference between the pathology groups in the efficacy of resection in eliminating the auras. Of the patients with hippocampal sclerosis who were rendered seizure free, 18.9% had persistent auras, whereas only one (2.6%) of the patients with temporal or extratemporal lesions who were rendered seizure free had persistent auras. These findings suggest that for patients with hippocampal sclerosis an anatomical dissociation between seizure and aura may occur, whereas this dissociation is not present in patients with lesions. Patients suspected of having hippocampal sclerosis should be counseled preoperatively as to the significant likelihood of persistent auras even if seizures are successfully abolished.
From the paper:
"Of the viscerosensory auras, most (79.3%) involved epigastric sensation, usually “rising,” but some were described as “nausea” or a “sickening feeling.” The experiential auras were mostly phenomena of déjà vu(23.8% of patients) or a feeling of fear (19%)."
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Long-term subdural strip electrocorticographic monitoring of ictal déjà vu
Weinand ME, Hermann B, Wyler AR, Carter LP, Oommen KJ, Labiner D, Ahern G, Herring A
Department of Surgery, University of Arizona College of Medicine, Tucson
Epilepsia 35(5): 1054-9, 1994
Abstract
We report a series of 8 patients with ictal déjà vu. Subdural strip electrocorticographic (ECoG) monitoring localized the ictal epileptogenic focus as follows: right (n = 6) and left (n = 2) mesiotemporal lobe. In all 8 patients, the left hemisphere was dominant for language function based on intracarotid amytal testing. In 6 right-handed patients, ictal déjà vu was associated with a right temporal lobe focus. However, in the 2 left-handed patients, the ictal focus was left temporal lobe. Although ictal déjà vu localizes the epileptic focus to temporal lobe, this experimental phenomenon appears to lateralize to the hemisphere nondominant for handedness.
Comment in:
Long-term subdural strip electrocorticographic monitoring of ictal deja vu [Epilepsia. 1995]
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Anatomical origin of déjà vu and vivid 'memories' in human temporal lobe epilepsy
Bancaud J, Brunet-Bourgin F, Chauvel P, Halgren E
INSERM U 97, Centre Paul Broca, Paris, France
Brain 117 (Part 1): 71-90, 1994
Abstract
Jackson (Brain 1898; 21: 580-90) observed that seizures arising in the medial temporal lobe may result in a 'dreamy state', consisting of vivid memory-like hallucinations, and/or the sense of having previously lived through exactly the same situation (déjà vu). Penfield demonstrated that the dreamy state can sometimes be evoked by electrical stimulation of the lateral temporal neocortex, especially the superior temporal gyrus. Halgren et al. (Brain 1978; 101: 83-117) showed that the dreamy state can be evoked by stimulation of the hippocampal formation and amygdala and Gloor (Brain 1990; 113: 1673-94) has suggested that it is evoked by lateral stimulation only when the resulting after-discharge spreads medially. In order to resolve the relative importance of these areas, we considered the mental phenomena observed in epileptic patients with electrodes stereotaxically implanted into different brain areas for seizure localization prior to surgical treatment. Sixteen patients, all with seizures involving the temporal lobe, experienced the dreamy state either as a result of spontaneous seizures (nine dreamy states in six patients), or due to electrical stimulation (43 in 14) or to chemical activation (five in three). Déjà vu and hallucinations of scenes were often evoked by different stimulations of the same electrode in the same patient. As Jackson had also observed, the dreamy state could occur alone but was often associated with epigastric phenomena and fear, and followed by loss of contact and oro-alimentary automatisms, and then by simple gestural automatisms, all characteristic of partial seizures beginning in the medial temporal lobe. Furthermore, as also emphasized by Jackson, the dreamy state was seldom associated with sensory illusions. Stimulation of either the neocortex (15 occurrences), anterior hippocampus (17) or amygdala (10) could evoke a dreamy state. However, since fewer hippocampal and amygdala leads were stimulated than temporal neocortical, the proportion of medial temporal electrodes where dreamy states could be evoked was much higher than in the neocortex. Most responsive lateral temporal sites were located in the superior temporal gyrus, rather than the middle temporal gyrus which was significantly less responsive. In 85% of dreamy states evoked by medial temporal lobe stimulation, the discharge spread to the temporal neocortex; and in 53% of dreamy states evoked by lateral temporal stimulation, the discharge spread medially. Considering all dreamy states, the amygdala was involved (as the stimulated structure, or as the site of ictal- or after-discharge) in 73% of cases, the anterior hippocampus in 83% and the temporal neocortex in 88%.
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Episodic Psychic Symptoms in the General Population
Ardila A, Nino CR, Pulido E, Rivera DB, and Vanegas CJ
Fundacion Universitaria Konrad Lorenz; and tInstituto Colombiano de Neuropsicologia, Bogota, Colombia
Epilepsia 34(1): 133-140, 1993
Summary
The frequency of some episodic psychic symptoms (dysmnesic, perceptual, and experiential) was determined in a 2,500-subject general population sample. Correlations with some risk factors eventually associated with nervous system dysfunctions (seizure history, head injury, car accident, hospitalization, febrile illness, and birth injury) were calculated. Subjects with one or several risk factors were more likely to report episodic psychic phenomena in daily life. Significant correlations of episodic psychic phenomena with sleep disorders, headache, allergies, and a history of learning disabilities were observed. We propose that some subclinical dysfunctions can be associated with the appearance of episodic psychic phenomena in otherwise normal subjects.
(Déjà vu discussed on page 134.)
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Neurobiological substrates of ictal behavioral changes
Gloor P
Advances in Neurology 55: 1-34, 1991
(Déjà vu treated on pp. 8-9. It is said that déjà vu always results from seizures or stimulation of the right temporal lobe and this has lateralization value (p. 9). A EEG tracing made while a patient was having a déjà vuexperience is shown in Fig. 3.)
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Experiential phenomena of temporal lobe epilepsy: Facts and hypotheses
Gloor P
Brain 113 (pt 6): 1673-1694, 1990
Abstract
Experiential phenomena that occur in temporal lobe seizures and can be reproduced by electrical stimulation of temporal lobe structures typically encompass perceptual, mnemonic and affective features, either in combination or in isolation, which commonly relate to the patient's individual past experience. These phenomena raise interesting questions concerning brain mechanisms involved in human psychophysiology. The anatomical substrates for the evocation of these phenomena are widely distributed within the temporal lobe and include temporal isocortex and limbic structures (amygdala, hippocampus and parahippocampal gyrus). Arguments are presented which indicate that experiential phenomena are positive expressions of temporal lobe and limbic function and do not result from its ictal paralysis. Recent concepts of parallel distributed processing (Rumelhart and McClelland, 1986) and the importance of parallel distributed cortical networks for higher cognitive functions (Goldman-Rakic, 1988a, b) provide a theoretical framework on which a hypothesis explaining experiential phenomena can be based. In conformity with these concepts the hypothesis assumes that temporal lobe epileptic discharge or electrical stimulation of temporal lobe structures can induce the elaboration of patterns of excitation and inhibition in widely distributed neuronal networks, some of which are capable of forming a specific matrix representing the substrate of a given experience. Neuronal networks engaged in parallel distributed processing (1) have the capacity to recreate the totality of a given experience when only a fragment of the network is activated, and (2) they tolerate a great deal of degradation by random inactivation of its components or by interference through random noise without serious loss of information content. These features are compatible with the assumption that localized epileptic neuronal discharge or electrical stimulation involving some temporal lobe structures could create a matrix representing features of individual experience of the kind activated in the course of temporal lobe seizures. Such an experience could, up to a certain limit, resist the degrading influence of mounting noise which inevitably must attend seizure discharge.
(Déjà vu appears on pp. 1674 and 1678.)
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The neuropathology of everyday life: The frequency of partial seizure symptoms among normals
Roberts RJ, Varney NR, Hulbert JR, Paulsen JS, Richardson ED, Springer JA, Shepherd JS, Swan CM, Legrand JA, Harvey JH, Struchen MA, Hines ME
Neuropsychology 4(2): 65-85, 1990
Abstract
Investigated the phenomenology of partial seizure-like symptoms in 3 studies. Although the findings from Study 1 with 661 undergraduates and Study 2 with 435 undergraduates demonstrated that normal individuals do report experiencing partial seizure-like phenomena, such symptoms are quite infrequent. Increased levels of symptom reporting were observed in healthy young adults who had experienced various risk factors for cerebral dysfunction (e.g., loss of consciousness due to head trauma, severe febrile illness in adulthood or adolescence). In Study 3, 15 selected brain-injured patients reported a breadth and frequency of partial seizure-like symptomatology that surpassed the limits of normal variability. Findings support the proposition that experiencing of partial seizure phenomena can be conceptualized on a continuum ranging from a healthy, essentially symptom-free state to overt central nervous system (CNS) dysfunction with multiple partial seizure symptoms.
(In a pilot study, 87% of 484 undergraduate students stated they had experienced déjà vu. In a subsequent study of 392 undergraduate psychology students in a control group, 68.3% said they either had never had such experiences or had them less than once a month. 23.2% said they had them at least once per month. 6.4% said they had them at least once a week. And 2% said they had them at least several times a week [Table 1, p. 69]. In a third study, the corresponding frequency values for 228 students were: 68.9%, 35.5%, 6.6%, and 1.3%. 0.4% maintained they had such experiences once a day and 0.4% said they had them more than once a day [Table 3, p. 75].)
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Electroencephalographic validation of a temporal lobe signs inventory in a normal population
Makarec K, Persinger MA
Journal of Research in Personality 24: 323-337, 1990
Abstract
In two separate experiments 61 18- to 35-year-old part-time university students were given the Personal Philosophy Inventory (PPI) that contained items that infer temporal lobe lability. Alpha activity seconds per minute during a 10-min recording (equal intervals of eyes opened or eyes closed) were obtained from the temporal and occipital lobes for each subject. Positive, intermediate strength correlations were obtained between the total numbers of different temporal lobe signs as measured by the questionnaire and both the average amount (eyes closed) of the variability in α activity from the temporal but not the occipital lobes. The results support the construct validity of the temporal lobe signs inventory and suggest that a continuum of temporal lobe lability (as inferred from both experimential and electroencephalographic criteria) exists within the normal population.
(Déjà vu is mentioned as one of the experiences that TLE patients have. p. 323)
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Psychiatric consequences of temporal lobectomy for intractable seizures: a 20-30-year follow-up of 14 cases
Stevens, J R 11
National Institute of Mental Health, Saint Elizabeth's Hospital, Washington, DC 20032.
Psychological medicine 20(3): 529-545, 1990
http://search.proquest.com/docview/80103736?accountid=14616
Abstract
Between 1958 and 1968, 14 patients from the epilepsy clinic at the University of Oregon Hospitals and Clinics with a diagnosis of temporal lobe epilepsy (TLE) had a temporal lobectomy for medically intractable seizures. Nine of the 14 patients operated on remained seizure-free over the 20-30-year period of follow-up. Between 6 months and one year following temporal lobectomy, two women, previously healthy from a psychiatric standpoint, developed psychoses, and the previous psychiatric problems of four other patients worsened. Two patients, one with incapacitating paranoid personality disorder and the other with explosive rage attacks preoperatively, had marked improvement in their psychiatric status following temporal lobectomy. The remaining six patients, all psychiatrically healthy prior to surgery, have had no change in psychiatric status following surgery. Development of psychosis or deterioration in psychiatric status after surgery was more common in patients with later age of onset, unreality or déjà vu rather than epigastric aura, pre-operative evidence of bilateral brain damage, and persistence of EEG or clinical seizure activity. Development of a chronic psychosis in psychiatrically healthy individuals many months after temporal lobectomy, even when seizures are arrested or ameliorated, suggests that anomalous synaptic regeneration may follow the surgery in these cases. Careful analysis of histories and outcomes may contribute to better understanding of the pathophysiology and anatomical substrates of psychoses.
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[Clinical aspects of paroxysmal states in children with depression]
[Paper in Russian].
Mamtseva, V N
Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova (Moscow, Russia : 1952) 89(8): 85-90, 1989
http://search.proquest.com/docview/79355624?accountid=14616
Abstract
In 81 depressed children aged 3 to 14 years the nonepileptic attacks could manifest the different psychopathological phenomena: 1, headaches before and after spells, non-systemic vertigo with imbalance and oculovestibular events with or without loss of consciousness; 2, orthostatic symptoms, syncope, cataleptoid seizures, Kloos seizures; 3, depersonalization and derealization episodes, deja vu and jamais vu states; 4, attacks with pain in the stomach and other organs, various other autonomic signs; 5, unsteady neurological signs: pareses, sensory, visual and speech disorders; 6, nightmares, oneiroid states, sleep-walking; 7, convulsive states, hyperkinesis; 8, psychomotor excitation and inhibition states; 9, behavioral spells with aggression. These states are differentiated from epileptic and hysterical attacks.
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Apparent complex partial seizures in a bipolar patient after withdrawal of carbamazepine
Garbutt JC, Gillette GM
Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine
Journal of Clinical Psychiatry 49(10): 410-1, 1988
Abstract
A 64-year-old woman with long-standing bipolar illness was treated with carbamazepine and clonazepam with minimal success. Discontinuation of carbamazepine and clonazepam was followed by episodic amnesia, purposeless behavior, déjà vu, and confusion. Although her EEG was normal, the episodes were compatible with complex partial seizures and ceased after carbamazepine and clonazepam were reinstituted. This case raises the question of whether discontinuing carbamazepine and clonazepam can induce complex partial seizures in bipolar patients.
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Paroxysmal “Feeling of Somebody Being Nearby”
Ardila A1, Gómez J
1Instituto Neurológico de Colombia, South America
Epilepsia 29(2): 188–189, 1988
DOI: 10.1111/j.1528-1157.1988.tb04417.x
Summary
Several days after a right temporal lobectomy for an astrocytoma, a patient experienced a paroxysmal feeling that somebody was nearby. This spontaneous phenomenon has only rarely been reported in the epilepsy literature but has been reported to be evoked by electrical stimulation of the right amygdala. Despite the rarity in the literature, such unusual experiential phenomena probably are seen more frequently in clinical practice.
From the paper:
"For the 4 months prior to surgery these being in a movie and deja vu sensations occurred,
often without generalization. Physical and neurologic examinations were normal."
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Temporal lobe epileptic signs and correlative behaviors displayed by normal populations
Persinger MA, Makarec K
Behavioral Neuroscience Laboratory, Laurentian University. Canada .
The Journal of General Psvchology 114(2): 179-195, 1987
Abstract
With regard to epileptic signs and correlative behaviors. one hypothesis is that the experiences and nonconvulsive behaviors of patients with electrical foci within the temporal lobe are also displayed. but with less intensity. by normal people. II this is correct, then there should be quantitative relationships between the numbers of major complex partial epileptic signs (CPES) and the occurrence of other frequent clinical experiences and behaviors. An inventory to answer this question was developed. Over a 3-year period, 414 (6 groups) university students were administered an inventory that included themes of CPES as well as control and information items. Strong correlations were consistently found between CPES scores and reports of paranormal (mystical. with religious overtones) experiences and "a sense of presence." Results from three personality (CPI. MMPI, and {PAT anxiety) inventories clearly demonstrated similar profiles. In addition to being more anxious, people who displayed higher CPES scores were more suspicious, aloof, stereotyped in their behavior. ruminative (overthinking), intellectually inefficient, and overly judgmental. CPES scores were significantly (p < .001) correlated with the schizophrenia and mania subscales of the MMPI. The results suggest that functional hyperconnectionisrn of cortical-limbic systems within the brain may be more prevalent in the normal population than previously suspected.
("Some of these experiences are remarkably similar to those that have been labeled paranormal or mystical henornena [Neppe, 1983; Persinger, 1983]. They include reports of deja vu, sensations of "a presence" [usually with mystical or religious overtones, leaving the body --mental diplopia; out-of-body experience], and precognition [knowing what is about to happen]. Frequently. the experiences are affected by situational context and modified by amnesia [Horowitz & Adams, 1970]." p. 180)
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Partial psychic seizures and brain organization
Ardila A, Monta'jes P, Bernal B, Serpa A and Ruiz E
Instituto Neurologico de Colombia
International Journal of Neuroscience 30: 23-32, 1986
Abstract
This research was an attempt to determine the cerebral areas involved in focal epileptic seizures accompanied by psychic manifestations. Six types of partial seizures involving psychic symptomatology and phonatory seizures were included in the study. Sixty-one clinical records of focal epilepsy, which had been revealed by means of a CT-scan examination, were analyzed and a subsample of 25 patients with psychic symptoms was selected. The scans taken of the lesions were transferred to a six-level standard template built for this purpose. Subsequently, templates of patients with the same type of seizures were superimposed. The critical zones for the seven types of seizures studied are presented. A clear correlation was found between these results and our present knowledge of functional brain organization.
(Déjà vu discussed on page 25.)
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Phenomenology of temporal lobe dysfunction: A link to atypical psychosis -- a series of cases
Tucker GJ, Price TRP, Johnson VB, McAllister T
Journal of Nervous and Mental Disease 174: 348-356, 1986
Abstract
This report is a phenomenological study of 20 cases of temporal lobe disorders manifested as complex partial seizures. The major behavioral symptoms observed were episodic affective disturbances, episodic cognitive disturbances, and "spells," with normal functioning between episodes. The remarkable similarity of this phenomenology to what has been described as atypical or episodic psychosis provides a possible theoretical link to the etiology of atypical psychosis. These cases also establish atypical psychosis as an entity clearly different from the other major psychoses.
From the paper:
"... the remaining reported behavioral symptoms only episodic physical violence (40%) and episodic nocturnal phenomena (25%), including ... Episodic olfactory hallucinations, episodic hyperacusis, déjà vu, deper- sonalization/derealization, severe unilateral headaches, abrupt ..."
(Déjà vu is listed under the symptoms in 6 of the 20 cases.)
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Temporal lobe signs and reports of subjective paranormal experiences in a normal population: A replication
Persinger MA, Valliant PM
Laurentian University
Perceptual and Molor Skills 60: 903-909, 1985
Summary
Correlations (r = 0.50) were found between the numbers of different psi (paranormal} experiences and the numbers of temporal lobe signs within a population of university students (n = 99). The strongest correlation of 0.60 occurred with a cluster of signs that are similar to symptoms reported by patients who show chronic foci in the mesiobasal temporal lobe. However, there were no significant correlations between numbers of different psi experiences and clusters of control items or a lie scale. Specific analyses of the 140 items of the inventory indicated only 23 reached statistical criterion (p < .001). Of these 17 were direct temporal lobe signs that implied deepened affect, auditory-vestibular experiences (vibrations, hearing one's name called), olfactory auras, perseveration ("forced" thinking), depersonalizarion, and sense of the personal. Five items involved beliefs about exotic phenomena or philosophical ideas. Only one item was from a control cluster, These results support the hypothesis that mystical or paranormal experiences are associated with transient electrical foci within the temporal lobe of the human brain. The repeated occurrence of these experiences within normal individuals may be embedded within a more complex symptomatology of temporal lobe signs.
(The results reported by Harper and Roth [1962] are referred to: "In 40% of the cases, features reminiscent of temporal lobe dysfunction, other than depersonalization, were present. These symptoms included deja vuexperiences or perceptual disorders such as olfactory or visual hallucinations."
And also: "Although temporal lobe epileptic patients showed more complete loss of consciousness than the group that displayed depersonalization syndrome, there were no differences between the two groups with respect to depersonalization, deja vu, formed hallucinations, illusions about bodily changes, and the idea of a 'presence.' Between 25% and 50% of the members of either group reported these symptoms; unfortunately, there were no reference ['normal'] group comparisons. The depersonalization group showed more frequent loss of feeling of familiarity and derealization that the group with epilepsy." p. 908)
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[Unusual dreams in epileptics]
[in Russian]
Boldyrev AI
Zhurnal Nevropatologii i Psikhiatrii Imeni S.S. Korsakova 84(6): 841-844, 1984
Abstract
The author discusses bizarre dreams characteristic of epileptics and never occurring in normal subjects which have an important practical implication especially for early detection of epilepsy and the prevention of severe forms of the disease. This group of dreams includes vivid nightmares with vital fear, dreams not infrequently transforming into pro-dream states; persistently repeated stereotyped dreams and dreams with invariably the same unpleasant sensations representing an isolated aura of subsequent epileptic attacks. Diagnostically important may also be dreams with the symptoms of derealization and depersonalization, vague dream images and the deja vu phenomenon.
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Psychomotor epileptic symptoms in six patients with bipolar mood disorders
Lewis DO, Feldman M, Greene M, Martinez-Mustardo Y
American Journal of Psychiatry 141: 1583-6, 1984
Abstract
Of 12 consecutive patients with bipolar mood disorders satisfying DSM- III criteria, six were discovered to have five or more psychomotor epileptic symptoms. All of the six had olfactory hallucinations, metamorphopsias, and multiple deja vu or mystical experiences. Each of them responded to lithium carbonate and had a first-degree relative with a bipolar disorder. The authors suggest that psychomotor symptoms may be more prevalent in bipolar patients than has hitherto been recognized.
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Depth recorded limbic seizures and psychopathology
Wieser HG
Dept. of Neurology, EEG, University Hospital, CH-8091 Zürich, Switzerland
Neuroscience & Biobehavioral Reviews 7(3): 427–440, 1983
Abstract
Chronically performed stereotaxic depth recordings in medically intractable epileptics offer a unique chance to study the correlation of epileptic discharges with changes of higher mental functions as well as behavioral and emotional alterations. From a quantitative study using 213 complex partial seizures from 29 selected patients with partial drug resistant epilepsy and from the observation of other patients with well defined epileptic perturbations of the limbic system and related sensory brain areas a good correlation between ictal signs and chronotopographical seizure patterns was obtained. The special role of mesiobasal limbic structures, i.e., amygdala and hippocampus, and its connections to hypothalamic and frontobasal-cingulate areas is highlighted by tracing the seizures. It is concluded that besides the short-lived ictal abberations of mental state and emotional sphere (“psychical seizures”) also some of the more prolonged behavior and personality changes seen frequently in patients with bitemporal basal spike foci might be attributed to narrowly confined limbic seizure discharges or to a “limbic dyscontrol syndrome” based on the altered activity of limbic structures due to the spike foci.
(From Table 2 on page 430 we learn that out of 27 patients, 6 had déjà experiences as part of their seizure auras. 13 of the 27 had tumors and 3 of them had déjà experiences.)
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Aura in temporal lobe epilepsy: Clinical and electroencephalographic correlation
Gupta AK, Jeavons PM, Hughes RC, Covanis A
Journal of Neurology, Neurosurgery and Psychiatry 46: 1079-1083, 1983
Summary
Patients with temporal lobe epilepsy were evaluated for their aura and the site of EEG abnormality. Autonomic and psychic auras were more frequently associated with right-sided temporal lobe lesions in 290 patients.
(Déjà vu more often associated with right temporal lobe abnormalities [p. 1081].)
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The role of the limbic system in experiential phenomena of temporal lobe epilepsy
Gloor P, Olivier A, Quesney LF, Andermann F, Horowitz S
Annals of Neurology 12(2): 129-144, 1982
Abstract
Experiential phenomena occurring in spontaneous seizures or evoked by brain stimulation were reported by 18 of 29 patients with medically intractable temporal lobe epilepsy who were investigated with chronic, stereotaxically implanted intracerebral electrodes. The phenomena mainly consisted of perceptual (visual or auditory) hallucinations or illusions, memory flashbacks, illusions of familiarity, forced thinking, or emotions. Experiential phenomena did not occur unless a seizure discharge or electrical stimulation involved limbic structures. For such phenomena to occur, seizure discharge or electrical stimulation did not have to implicate temporal neocortex. This was true even for perceptual experiential phenomena. Many experiential responses elicited by electrical stimulation, particularly when applied to the amygdala, were not associated with electrical afterdischarge. Limbic activation by seizure discharge or electrical stimulation may add an affective dimension to perceptual and mnemonic data processed by the temporal neocortex, which may be required for endowing them with experiential immediacy.
(An EEG recording of a patient having a déjà vu experience. p. 133. See Fig. 3 on p. 134.)
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The lateralising significance of hypergraphia in temporal lobe epilepsy
Roberts, J K; Robertson, M M; Trimble, M R
Journal of neurology, neurosurgery, and psychiatry 45(2): 131-138, 1982
http://search.proquest.com/docview/74042520?accountid=14616
Abstract
Six patients with hypergraphia and epilepsy are presented and their clinical features compared with other patients reported in the literature. It is suggested that hypergraphia occurs more frequently in patients with right-sided non-dominant temporal lobe lesions, in contrast for example to the schizophreniform presentation of left-sided lesions. Other features of psychopathology possibly associated with non-dominant lesions, including elation, hypereligiosity and déjà vu experiences, are also discussed.
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Neuropsychiatric and electroencephalographic aspects in the diagnosis of complex partial seizures
Remick RA, Wada JA, Miles JE
Canadian Journal of Psychiatry 26(2): 49-52, 1981
The authors review from a psychiatric perspective some of the elect roencephalographic techniques that may assist the clinician in diagnosing comple x partial seizures (temporal lobe epilepsy). Routine scalp electroencephalograms may not detect temporal lobe EEG abnormalities, leading to the false impression of pseudo or hysterical seizures. Knowledge of the advantages of a sleep recording, specialized EEG electrodes (nasopharyngeal, sphenoidal), and natural or pharmacological activation techniques will increase one's diagnostic acumen. The authors discuss the appropriate use of these methods and their relevance to psychiatry.
(The authors report on four cases. The patient in case 3 had "a 10 year history of déjà vu episodes." p. 51)
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The uncinate focus and dreaming
Epstein AW, Freeman NR
Epilepsia 22(5): 603-5, 1981
Summary
The relationship of uncinate epilepsy to the dreaming process is illustrated by a case study in which an identical olfactory sensation appeared in both daytime and nocturnal dreams.
(Déjà vu is mentioned on p. 605)
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Is déjà vu a symptom of temporal lobe epilepsy?
Neppe VM
South African Medical Journal 60(23): 907-8, 1981
Abstract
The definition and conceptualization of the déjà vu phenomenon are interpreted in various ways. The common occurrence of déjà vu is the general population stresses the need for the development of specific qualitative features which will be valuable in the diagnosis of temporal lobe epilepsy.
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Psychische Störungen bei Epilepsien
[Psychological disorders in epilepsies] [in German]
Fröscher W
Zeitschrift für Allgemeinmedizin 55: 488-496, 1979
Zusammenfassung
Psychische Störungen bei Epilepsien sind nicht selten. Man beobachtet dieselben organischen Psychosyndrome wie sonst bei körperliche begründbaren Psychosen. Sie können als Prodomi von Anfällen, als Anfallssymptom, postkonvulsiv und im anfallsfreien intervall auftreten. Für das therapeutische Vorgehen besonders wichtig ist die Kenntnis der Alternativpsychosen, der pharmakogenem Durchgangssyndrome und des Petit-mal-Status. Reaktive psychische Veränderungen wie depressive Verstimmungen mit Minderwertigkeitengefühlen sind die Folge realer Benachteiligungen in vielen Lebensbereichen. Wichtigstes Therapieziel ist auch bei diesen Patienten die Erlangen von Anfallsfreiheit.
[Summary
Psychological disorders are not seldom in epilepsies. One observes the same organic psychological syndromes as otherwise [seen] in soma-based psychoses. They can occur as prodomal [stages] of seizures, as seizure symptoms, post-convulsions and in seizure-free intervals. Especially important for therapeutic procedures is the knowledge of alternative psychoses, the pharmagenetic transition syndromes and the petit-mal status. Reactive psychological alterations such as depressive moods with inferiority feelings are the consequence of real disadvantages in many areas of life. Also with these patients, the most important aim of therapy is achieving freedom from seizures.]
(Déjà vu treated on p. 489.)
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Relationship of hallucinations to the depth structures of the temporal lobe
Weingarten SM, Cherlow DG, Halgren E
Under: Neurosurgical Treatment. In: Psychiatry, Pain and Epilepsy, W. H. Sweet, S. Obrador and J. G. Martin-Rodriguez (eds.), Baltimore: University Park Press, 1976
(This paper reports the results of recordings and stimulations via electrodes "placed bilaterally in the depth structures of the temporal lobe as well as over the calvarium to monitor the electrical activity of the brain during the ictal and interictal states." The patients "suffered from temporal lobe epilepsy intractable to intensive pharmacologic regimens." The table on pages 562-3 shows that 5 patients [19 stimulations] reported déjà vufeelings.)
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Psychische Veränderungen bei Epilepsien
[Psychological alterations in epilepsy] [in German]
Hebenstreit G
Wiener Medizinische Wochenschrift 125: 360-4, 1975
(Déjà vu, déjà entendu, and déjà vécu experiences are mentioned as examples of "dreamy states" in psychomotor seizures. p. 360.)
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Ictal clinical manifestations of complex partial seizures
Daly DD
Advances in Neurology 11: 57-83, 1975
(Déjà vu treated on pp. 69-70 and includes a quotation of the famous passage from David Copperfield.)
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Temporal lobe epilepsy: Its possible contribution to the understanding of the functional significance of the amygdala and of its interaction with neocortical-temporal mechanisms
Gloor P
In: The Neurobiology of the Amygdala, Basil E. Eleftheriou (ed.). NYC: Plenum Press, 1972, pp. 423-457
(Examples of déjà vu during TLE seizures are given on pp. 441-3.)
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Clinical course and prognosis of temporal lobe epilepsy
Currie A, Heathfield KWG, Henson RA, Scott DF
Brain 94: 173-190, 1971
(The authors included a survey of 666 TLE patients and report a 14% incidence of déjà vu.)
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Temporal lobe epilepsy
Reef HE
The Leech 40: 63-5, 1970
("In these seizures the patient suddenly experiences a disturbance of normal thought processes when strange illusions or hallucinations dominate his mental state. He may feel as if he is in a dream and he is usually temporarily out of touch with his surroundings during the attack. The most typical example is the "deja vu" attack in which there is a feeling of familiarity when in strange surroundings or situations. Deja vu means 'already seen'. This same familiarity with the unfamiliar may also apply to other situations. While listening to a speech, the patient may suddenly get a feeling as if he has heard it all before. On meeting a strange person, there is a sudden feeling of knowing the face and having been introduced before. A variety of deja vu is a feeling of reliving events from the past. These sensations occur in normal people but infrequently with different patterns each time. When they occur frequently with the same recurring pattern each time then a temporal lobe disorder should be suspected." p. 63)
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Memory disorders and the temporal lobe
Whitty CWM
Chapter 9 in: Current Problems in Neuropsychiatry, Schizophrenia, Epilepsy, and the Temporal Lobe. R. N. Herrington (ed.), Special publication (no. 4) of the British Journal of Psychiatry, 1969, pp. 55-59
(Déjà vu is mentioned twice in connection with symptoms of temporal lobe epilepsy. pp. 57, 58)
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The clinical neurology of temporal lobe disorders
Simpson JA
Chapter 7 in: Current Papers in Neuropsychiatry: Schizophrenia, Epilepsy, The Temporal Lobe. R. N. Harrington (ed.), Headley Brothers, Ltd., Kent, 1969, pp. 42-8
(Also published as British Journal of Psychiatry, Special Publication no. 4)
("If a pattern of stimuli evokes the 'coincidence' or 'déjà vu' response it will appear familiar even if it is completely novel. ... Note that although some record of previous stimuli must be available in the nervous system it does not need to be localized, but the phenomena of temporal lobe epilepsy suggest that this area has important coincidence detection circuits." p. 46)
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Dreamy states
Janz D
In: Die Epilepsien: Spezielle Pathologie und Therapie, Stuttgart: Georg Thieme Verlag, 1969, pp. 180-7
(He writes that déjà vu, jamais vu, déjà entendu, déjà vécu, déjà raconté and déjà éprouvé do not normally occur at the same time. He adds that the first ones are more prevalent than the latter ones. p. 181)
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Interhemispheric integration of identity relationships
Groh LA
Psychiatria, Neurologia, Neurochirurgia 71(2): 185-191, 1968
Abstract
A concept of identity formation as an integrating and creative dominant-recessive or conscious and unconscious ego formulation is evident in the behavioral relationships between the group and its leader, between the individual and society as expressed in the media of culture, and in the individual's bipersonal or self-god relationships. In epileptics with deja vu auras the frequency of origination of this identity aura within the temporal lobe or associated frontal lobe areas in the hemisphere that is recessive for handedness suggests that this phenomenon is a dual consciousness of recessive identity content. Certain dreams and anxiety state and fatigue identity auras as well as the various forms of schizophrenia and creative gifts are also shown to be expressions of this dominant-recessive integration or failure of integration. Other possible modes of expression of this ordinarily interdependent identity relationship are the creative spiritual values of faith, hope, and love and the destructive results of a perversion of this relationship with the relatively disorganized recessive identity in unchecked dominant control of behavior rather than being realized through an integral function of the usual dominant identity area. It is likely that there are inborn variations in the degree of dominance for identity and instances of ambivalence of function.
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Amphetamine psychosis: II. Theoretical implications
Ellinwood Jr EH
International Journal of Neuropsychiatry 4(1): 45-54, 1968
Abstract
Many symptoms of temporal lobe epilepsy are presented in the amphetamine psychosis including deja vu, jamais vu, complex visual hallucinations, and olfactory hallucinations. The paranoid psychosis seen in temporal lobe epilepsy is similar to the amphetamine psychosis. Many of the symptoms, including hallucinations, comprise recognition phenomena and their emotive counterparts. The limbic system and the temporal lobes are probably involved in relating present experience to past categories, especially the emotional interpretation of experiences. As with the Kluver-Bucy monkeys, many amphetamine psychotics have difficulty in locating past standards, but there is also stimulation of certain visual, sexual and aggressive behavior patterns. There appears to be hyperalertness to stimuli in the lateral periphery and hyperactivity of certain minor hemisphere functions. A hypothesis for 1 attentional system of the cerebral cortex and its relation to the amphetamine psychosis is presented. (52 ref.)
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Memory changes induced by stimulation of hippocampus or amygdala in epilepsy patients with implanted electrodes
Chapman LF, Walter RD, Markham CH, Rand RW, Crandall PH
Transactions of the American Neurological Association 92: 50-6, 1967
(Déjà vu mentioned on p. 50.)
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Deja vu in temporal lobe epilepsy
Cole M, Zangwill OL
Journal of Neurology, Neurosurgery and Psychiatry 26: 37-8, 1963
(This two-page paper is available on-line at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC495533/ )
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Über Störungen des Zeiterlebens in der epileptischen Aura
[About disorders of time experience in the epileptic aura] [in German]
Hallen O
In: Zeit in nervenärtzlicher Sicht, Georg Schaltenbrand (ed.), Stuttgart: Ferdinand Enke Verlag, 1963, pp. 104-111
(Déjà vu seldom among epilepsy patients: 6 out of 2940. p. 106)
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Temporal lobe epilepsy and the phobic anxiety-depersonalization syndrome. Part 1: A comparative study
Harper M, Roth M
Comprehensive Psychiatry 3(3): 129-151, 1962
(Unless other features are taken into account, the mere presence of déjà vu [d.v.] sensations "cannot be regarded as establishing a diagnosis in a doubtful case" of either phobic anxiety-depersonalization syndrome [P.A.D.S.] or temporal lobe epilepsy [T.L.E.] [p. 138]. Table 5 on p. 139 shows that out of 30 cases of P.A.D.S., 12 had d.v. experiences and, out of 30 cases of T.L.E., 7 had such experiences. This difference was not significant.)
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Psychomotor (psychic, temporal) epilepsy
Lennox WG, Lennox MA
In: Epilepsy and Related Disorders, Boston: Little Brown & Co., 1960
(Various accounts of déjà vu experiences among temporal lobe epileptic patients are related. pp. 244-5, 274-9, 284-5. On p. 276, the authors wrote: "Déjà vu [already seen], déjà vécu[already lived], déjà raconté [already told], déjà éprouvé [already tested], and déjà entendu [already heard]; these various French words distinguish the different manifestations of a peculiar experience which many persons with temporal epilepsy report. However, "déjà vu" is commonly used for any and all of these subjective phenomena.")
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"Psychomotor" or "temporal lobe" epilepsy
DeJong RN
Neurology 7(1): 1-14, 1957
(This paper contains several references to déjà vu, reminiscence and dreamy states.)
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Ictal depression and anxiety in temporal lobe disorders
Weil AA
American Journal of Psychiatry 113: 149-157, 1956
(Déjà vu occurred in the auras of 2 patients.)
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O sintoma do ja-visito e epilepsia temporal
[The déjà visité symptom and temporal epilepsy] [Article in Portuguese]
Lopes JL, Barbosa RT, Fernandes I
Jornal Brasileiro de Neurologia 8(1-2): 1-16, 1956
Summary
1) A patient with psychomotor epilepsy of the "deja-vu" variety has been studied by the authors.
2) A focal dysrythmic alteration of the temporal lobe has been confirmed by the electrocorticography [sic]
3) The remotion [removal?] from the alterated [altered] temporal lobe has produced a normalization of the EEG
4) After two months, the crises have lessened in frequency and intensity and the personal behavior is must [much] improved.
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Clinical applications of EEG in psychiatry
Hill D
Journal of Mental Science 102: 264-271, 1956
(He says that epileptic déjà vu tends to be brief and momentary. p. 271)
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Psychical seizures
Penfield W, Jasper H
Chapter 11 in: Epilepsy and the Functional Anatomy of the Human Brain. Little, Brown & Co., Boston, 1954
("He has the feeling that he remembers his present environment, that he has been here before or has experienced all this at another time. This is quite a common illusion, a sense of false familiarity. It has been called the 'already seen,' or the 'déjà vu' phenomenon." p. 439)
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Das oral-petit mal. Beschreibung und Zergliederung der als uncinate-fit (Jackson) und psychomotor-fit (Lennox) bezeichneten epileptischen Äquivilante
[The oral-petit seizure. Description and analysis of the epileptic equivalents that are designated as being uncinate seizures (Jacksion) and psychomotor seizures (Lennox)] [in German]
Hallen O
Deutsche Zeitschrift f. Nervenheilkunde 171: 236-260, 1954
(Déjà vu experiences of epileptics are described. pp. 253-6)
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Observations on epileptic automatism in a mental hospital population
Liddell DW
Journal of Mental Science 99: 732-748, 1953
Summary
1. The history of temporal lobe epilepsy is reviewed
2. The epileptic population of the hospital was investigated clinically and retro-encephalographically as a probable source of temporal lobe dysfunction
3. A temporal lobe focus in the E.E.G. was found to occur in 50 per cent. of the epileptic population, and in 78 per cent. of the patients was associated with a clinical automatism.
4. Association of personality disturbances and automatism was noted.
(Kinnier Wilson [1928] classified the dreamy states in four main groups:
1. The familiarity or déjà vu type
2. Unfamiliarity, strangeness or unreality type
3. The "Panoramic memory" type
4. The incomplete or abortive type. p. 734)
SAK Wilson Modern Problems in Neutology, 1928
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Epileptic anamnesis
Hill D, Mitchell W
Folia psychiatrica, neurologica et neurochirurgica Neerlandica 56: 718-725, 1953
(Instances of déjà vu as part of seizure auras are included in the case studies they present. pp. 722-3)
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So-called "psychomotor" and "temporal" epilepsy
Gastaut H
Epilepsia 2(11): 59-76, 1953
(On page 62 déjà vu mentioned as an ictal symptom; there is extensive discussion of this paper in the pages that follow it.)
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Memory mechanisms
Penfield W
American Medical Association Archives of Neurology and Psychiatry 67: 178-191, 1952
("It should be pointed out that the temporal cortex is obviously utilized in the interpretation of current experience. Every clinician is aware that minor epileptic seizures which involve the temporal region may produce misinterpretation, an illution of interpretation. For example, the patient may have the sudden feeling that this has all happened before, the déjà vuphenomenon.
"Illusions of this and other types may be produced by stimulation of the temporal cortex, as well as by local epileptic discharge. The disturbance produced is one of judgment in regard to present experience -- a judgment that the experience is familiar, or strange, or absurd; that distances and sizes are altered, and even that the present situation is terrifying." p. 190)
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Epilepsy in association with intracranial tumour
Lund M
Acta Psychiatrica et Neurologica Scandinavica Suppl. No. 81: 1-149, 1952
(The paper includes a section on the dreamy state with clinical examples. The classification scheme of SA Kinnier Wilson is cited. pp. 57-64 -- see SAK Wilson, Problems of Modern Neurology, 1928, p. 51.)
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Phenomena and correlates of the psychomotor triade
Lennox WG
Neurology 1: 357-371, 1951
(Of 414 patients [538 seizure patterns], 7% exhibited déjà vu/dreamy states. p. 365)
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Psychomotor Epilepsy: Types of paroxysmal syndromes
Gibbs EL, Gibbs FA, Fuster B
Archives of Neurology and Psychiatry 60(4): 331-339, 1948
(Of 300 patients with psychomotor seizure discharge, 4 [1.3%] had déjà vu experiences. p. 337)
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Dreamy states, epileptic aura, depersonalisation and psychastenic fits: A few comments and reflections
Antoni N
Acta psychiatrica et neurologica 21(1-3): 1-20, 1946
(Déjà vu is mentioned on pp. 9, 12, 16, and 17. He wrote "Little is gained ... by calling a simple déjà-vuphenomenon epileptoid and, for that matter, it would not be entirely suitable, for this phenomenon is so common, even in healthy persons. [page 17])
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Paroxysmal disturbances of consciousness in verified localized brain affections with special regard to the so-called "dreamy states"
Hermann K, Strömgren E
Acta Psychiatrica et Neurologica 19: 175-194, 1944
(They reviewed the clinical material of 644 epilepsy patients [358 men and 286 women] that had been admitted to the Department of Neurosurgery of the Rigshospital, Copenhagen. There were a total of 63 cases of temporal lobe epilepsy. Of those, 3 males and 5 females exhibited increased recognition as part of their seizure auras. Déjà vu is mentioned in this connection on p. 188.)
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Epilepsy: A paroxysmal cerebral disrhythmia
Gibbs FA, Gibbs EL, Lennox WG
Brain 60: 377-388, 1937
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Aura in epilepsy: A statistical review of 1,359 cases
Lennox WG, Cobb S
Archives of Neurology and Psychiatry 30: 374-387, 1933
(Of 750 patients reporting auras, 1 had a "sense of having seen" and 1 had a dreamy state [first part of Table 3 on p. 380])
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Selected Writings of John Hughlings Jackson
Hughlings Jackson J
James Taylor (ed.), London: Hodder & Stoughton, Ltd., Vol. 1, 1931
("The dreamy state in the uncinate group of epileptics varies very much in different cases. In A. B. it was the peculiar intellectual state which many healthy people or people slightly out of health have occasionally -- Reminiscence. It is quite evident tha tin some slight epileptic paroxysms with the dreamy state -- in all of them, I believe -- there is a kind of double consciousness -- a 'mental diplopia'." p. 467-8)
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Zur Symptomatologie der Erkrankungen des rechten Schläfenlappens
[Concerning the symptomatology of diseases of the right temporal lobe] [in German]
Hauptmann A
Deutsche Zeitschrift für Nervenheilkunde 117-119(1): 170-183, 1931
Zusammenfassung
Es wird über einen Tumor des rechten Schläfenlappens berichtet, der 11 Jahre lang nur petit-malartige Zustände machte, ehe lokalisierte und Hirndruck-Symptome auftraten. Die Lokalsymptome ließen eher an einen basalen Tumor denken. Hemianopsie sollte den Verdacht auf eine Beteiligung des Temporallappens lenken. Temporallappen-Tumoren machen röntgenologisch nachweisbare Veränderungen am Felsenbein. Mikropsie-Makropsie und déjà-vu-Zustände sind Ausdruck einer Affektion des Schläfenlappens.
[Summary
Here we report on a tumor on the right temporal lobe that for 11 years only produced petit-mal-type conditions, where more localized and cerebral pressure symptoms occurred. The local symptoms gave one to suspect a basal tumor. An hemiaopsy should lead one to suspect an involvement of the temporal lobe. Temporal lobe tumors make alterations in the petrous bone visible in x-rays. Microscopy-makroscopy and déjà vu states are expressions of an affection of the temporal lobe.]
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Nervous semeiology, with special reference to epilepsy
Wilson SAK
British Medical Journal July 12, 1930 pp. 50-54
("An intelligent lady of 32 suffers. from attacks wlhich belong to the uncinate variety of so-called idiopathic epilepsy, and are characterized by a 'dreamy state' aura with a strong feeling of familiarity or déjà vu; in her own words, 'Ifeel as if my mind and my body are coming apart'; or again, 'I can see myself walking in the garden as if my mind were looking at myself from afar.' This peculiar mental state is accompanied by a defilnite feelinig of pleasure, so much so that at first the patient used to welcome tile sensation as a 'dream of delight'; the precise pleasurable element, however, she has never been able to specify. At a later stage the fits became few and far between, andl confined largely to the briefest of déjà vu auras without any pleasurable component; for nine years now she has had none at all." p. 52)
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The psychical components of temporal (uncinate) epilepsy
Wilson SAK
Chapter IV in: Modern Problems in Neurology. London: Edward Arnold & Co., 1928, pp. 51-75
(In this book chapter, the author provided excellent overviews of what he found to be four main types of the Jacksonian "dreamy state":
I. The "familiarity" or "déjà vu" type
II. The "unfamiliarity," "strangeness," or "unreality" type
III. The "panoramic memory" type
IV. The incomplete or abortive type. p. 53)
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(a case report)
Collin M
L'Encéphale 8: 93-94, 1913
(He reports on a case of a young woman suffering from epilepsy who has déjà vu experiences.)
(There is a discussion by G. Ballet, the journal editor, where he distinguishes between déjà percu [already perceived] and déjà vécu [already experienced or lived through].)
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The symptomatology of temporosphenoidal tumors
Kennedy F
The Archives of Internal Medicine 8: 317-350, 1911
(He includes descriptions of Jacksonian dreamy states occurring in connection with what is now known as temporal lobe epilepsy. pp. 325-7)
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"Psychosyndrom" bei temporaler Schädigung
["Psychosyndrome" in cases of temporal lobe damage] [in German]
Berner P
Section 3.2 in: Psychiatrische Systematik: Ein Lehrbuch. Bern: Verlag Hans Huber, 1911
(Déjà vu, déjà vécu and déjà entendu mentioned in connection with derealization and depersonalization occurring in TLE seizure auras on p. 227. Déjà vu is mentioned in connection with Jacksonian "dreamy states" on p. 262.)
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The Hughlings-Jackson lecture on special sense discharges from organic disease
Gowers WR
Brain 32: 303-326, 1910
("Precurrence" or already experienced before mentioned on p. 307.)
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The cerebral centers for taste and smell and the unciate group of fits
Mills CK
Journal of the American Medical Association 51: 879-885, 1908
(This is basically a case report; Jacksonian dreamy states are mentioned. p. 882)
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Das Grenzgebiet der Epilepsie
[The Frontiers of Epilepsy] [in German]
Gowers WR
Leipzig: F. Deuticke Verlag, 1908
(See p. 21.)
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Two cases illustrating points in the diagnosis of tumour or other lesion of the uncinate region of the temporo-sphenoidal lobe
Buzzard T
The Lancet, June 30, 1906, pp. 1807-1810
(He mentions a case in which a woman tells of false recognition during a "dreamy state".)
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Clinical studies
Pick A
Brain 26(2): 242-267, 1903
DOI: https://doi.org/10.1093/brain/26.2.242
(The first study is entitled: 1.--On "Dreamy Mental States" as a Permanent Condition in Epileptics.)
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Epileptic attacks with a warning of a crude sensation of smell and with the intellectual aura (dreamy state) in a patient who had symptoms pointing to gross organic disease of the right temporo-sphenoidal lobe
Hughlings-Jackson J, Stewart P
Brain 22: 534-549, 1899
("This smell was succeeded by what is commonly called an intellectual aura (dreamy state), in which -- to use his own words -- he 'felt as if he were saying, doing, and looking at things which he had experienced before.'" p. 535)
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Case of epilepsy with tasting movements and "dreamy state" -- very small patch of softening in the left uncinate gyrus
Hughlings-Jackson J, Colman WS
Brain 21: 580-590, 1898
("He had that variety of dreamy state I call 'reminiscence'; he called it 'recollection.' In his slight attacks there was, he told me, a sentence in his mind which was as if remembered. For example, if anyone was at the same time speaking to him it would be as if he (Z) were trying to remember it, as if were familiar, but yet he could not remember it." p. 581)
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The Cavendish Lecture on dreamy mental states
Crichton-Browne J
The Lancet, July 6, 1895, pp. 1-5, 74-75
(He includes an excellent review of the literature [of that time] about dreamy states on pp. 1-2.)
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On a particular variety of epilepsy ("intellectual aura"), one case with symptoms of organic brain disease
Hughlings-Jackson J
Brain 11: 179-207, 1888
("I would never, in spite of Quaerens' case, diagnose epilepsy from the paroxysmal occurrence of "reminiscence" without other symptoms, although I would suspect epilepsy." p. 186)
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On right or left-sided spasm at the onset of epileptic paroxysms, and on crude sensation warnings, and elaborate mental states
Hughlings Jackson J
Brain 3: 192-206, 1880-1
("I speak first of certain highly elaborate mental states, sometimes called 'intellectual aurae.' I submit that the term 'intellectual aura' is not a good one. The state is often like that occasionally experienced by healthy people as a feeling of 'reminiscence,' that on which Coleridge, Tennyson, Dickens, and many others have written. It is sometimes called 'dreamy feelings,' or is described as 'dreams mixing up with present thoughts,' 'double consciousness,' 'feeling of being somewhere else,' 'as if I went back to all that occurred in my childhood.'" pp. 199-200)
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Notes on Cases of Diseases of the Nervous System
Hughlings-Jackson J
Medical Times and Gazette Dec. 23, 1876, pp. 700-2
("The elaborate mental state, or so-called intellectual aura, is always the same, or essentially the same, for each case. "Old scenes revert." "I feel in some strange place" (a boy expressed it -- in a strange country") - "A dreamy state." "A panorama of something familiar and yet strange." "If I were walking along and had a fit , I should think 'Oh, I saw that before!'" Such a feeling of reminiscence is not very uncommon." p. 702)
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Doppelwahrnehmungen
[Double perceptions] [in German]
Jensen J
Archiv für Psychiatrie 4: 547-558, 1874
(He discusses a case of epilepsy with double perception [déjà vu] and bases his ideas on the fact that we have two cerebral hemispheres.)
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A prognostic and therapeutic indication in epilepsy
"Quaerens"
The Practioner 4: 284-5, 1870
(The author quoted examples of déjà vu from Coleridge, Tennyson and Dickens but then contends that it must represent a "disturbance of brain function." He said he had had such experiences in his boyhood and now was "subject to occasional epilepsy". He thus felt doctors should be sensitized to this as a possible early indication of an epileptic disorder.)