Blog #20: Pre-Meditated Violent Behavior During Seizures Does Not Occur

(This blog was originally posted on March 5, 2012)

 

 

Violent behavior in epilepsy is most associated with complex partial seizures. People who are physically restrained while suffering a complex partial seizure often involuntarily strike out. Weapons may be used but only if they are readily at hand during the struggle. The violent response to the restraint is a non-directed, unconscious defense mechanism; patients will not recall their outburst after the seizure.

 Pre-meditated violent and criminal behavior during a seizure does not occur in the real world, despite what popular novels and movies would have us believe. In Michael Crichton’s sci-fi thriller, The Terminal Man, a man with epilepsy undergoes brain surgery to implant electrodes that will affect seizures. The novel’s plot includes maniacal attacks, but this violence is planned by the fictional character. The planning required for an attack requires reasoned conscious thoughts. Such reasoning does not occur in complex partial seizures. During a seizure, the person is in a mental fog, unable to relate consciously to his surroundings (see Complex Partial Seizure on the EPILEPSY INFORMATION tab at the right on this website).

Epilepsy and violence are also described in Shakespeare’s canon. In Othello, Othello is a known epileptic as stated by his trusted but disloyal companion, Iago. Othello’s seizure is preceded by a severe emotional stress when Iago famously drops Desdemona’s handkerchief for Othello to find. This causes Othello, Desdemona’s husband, to fly into a jealous rage. Othello then becomes confused, saying: “It is not words that shake me thus. – Pish! Noses, ears and lips? Is’t possible?—Confess?—Handkerchief?—O devil! (he falls in a trance).” (Act IV, scene 1, line 41).

At that moment Iago says: “…My lord is fall’n into an epilepsy. This is his second fit; he had one yesterday.”

Cassio, an observer, says: “Rub him about the temples.”

And Iago responds: “No, forbear. The lethargy must have his quiet course. If not, he foams at the mouth, and by and by breaks out to savage madness. Look, he stirs. Do you withdraw yourself a little while. He will recover straight.”

Anyone familiar with complex partial seizures will recognize the classical nature of Othello’s seizure. Later in the play Othello murders his wife during a jealous rage. Who would not think that in our 21st century a criminal lawyer could have had Othello found innocent—or at least guilty of a far less serious charge—by telling the court that his client, a known epileptic, was not responsible for his action? Othello’s plea of innocence would have been strengthened further if a witness had testified that he had heard Desdemona crying out as she was being strangled: “And yet I fear you; for you’re fatal then when your eyes roll so.” (Act V, scene 2, line 40). Othello’s lawyer would argue that her demise obviously occurred while he was in a seizure.

 

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.