Epilepsy and homicide

Neil S Pandya,¹ Mirna Vrbancic,² Lady Diana Ladino,^3,4 José F Téllez-Zenteno<sup>3

1</sup>Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; ²Department of Clinical Health Psychology, Royal University Hospital, Saskatoon, Saskatchewan, Canada; ³Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; ⁴Department of Neurology, College of Medicine, University of Antioquia, Medellin, Colombia

Purpose: We report the rare case of a patient with intractable epilepsy and escalating aggression, resulting in murder, who had complete resolution of her seizures and explosive behavior following a right temporal lobectomy.
Patients and methods: We searched the available literature from 1880 to 2013 for cases of epilepsy being used as a court defense for murder and collected information regarding the final sentencing outcomes. We selected 15 papers with a total of 50 homicides.
Results: We describe the case of a 47-year-old woman with drug-resistant right temporal epilepsy who developed increasing emotional lability, outbursts of anger and escalating violent behavior culminating in a violent murder. The patient was imprisoned while awaiting trial. In the interim, she underwent a successful temporal lobectomy with full resolution of seizures, interictal rage and aggressive behaviors. After the surgery, her charges were downgraded and she was transferred to a psychiatric facility.
Conclusion: The aggressive behavior associated with epilepsy has been described in the literature for over a century. A link between epilepsy and aggression has been disproportionally emphasized. These patients share some common characteristics: they are usually young men with a long history of epilepsy and lower than average intelligence. The violent act is postictal, sudden-onset, more likely to occur after a cluster of seizures and is usually related with alcohol abuse.

Keywords: aggression, crime, epilepsy surgery, murder, temporal lobectomy