This paper deals with an epileptic patient (27-yr-old, left-handed man) in whom paroxysmal discharges were elicited by decision making and psychic tension at the time of writing, calculation and constructive acts. On general EEG examination, no abnormal findings were observed. On 'neuropsychological EEG activation' (EEG activation by use of neuropsychological tasks, such as reading, speaking, writing, calculation, constructive acts, etc.), however, generalized spike and wave complexes and/or high voltage sharp waves were induced by writing, calculation and constructive acts; among them, writing showed the most significant activation effect. Such paroxysmal discharges were higher in amplitudes over the frontal-central areas, often skewed to the right frontal area. An analysis of the number of induced paroxysmal discharges with writing against the time course revealed the following: the paroxysmal discharges tended to appear just prior to writing; and they occasionally appeared during the period of explanation about tasks to the patient, as well as when he was not able to respond to questions properly. These results suggest that decision making as well as psychic tension may play the most significant role in the occurrence of paroxysmal discharges in this patient. Based on these findings, a diagnosis of decision-making epilepsy, first proposed by Forster (1975), was made. The clinical EEG findings of this patient are discussed chiefly in comparison with 2 cases of decision-making epilepsy of Forster. It is stressed that neuropsychological EEG activation may be useful for diagnosing of decision-making epilepsy and allied types of epilepsy.
|Number of pages||11|
|Journal||Psychiatria et Neurologia Japonica - Seishin Shinkeigaku Zasshi|
|Publication status||Published - 1981 Jan 1|
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