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Neuro-Physiology and Behaviour Disorders in Epileptic Children^*

Edward J. A. Nuffield, M.D., D.P.M.

The Maudsley Hospital, London, S.E.5

^* Abbreviated from part of an unpublished M.D. thesis.

Present address: Royal Prince Alfred Hospital, Newtown, Australia.

ABSTRACT

1. The question of behaviour disorders in epileptic children has usually been tackled without much attention being paid to the different neuro physiological patterns or the complexity of the behavioural picture.
   
2. It is necessary to consider epileptic children as failing into physiologically distinct groups, though the overlap is great and in many cases no adequate understanding of the underlying physiological disturbance is possible. This is largely due to the inadequacy of our present-day investigatory methods.
   
3. Nevertheless it is possible to isolate two subgroups in whom the rhinencephalic and the centrencephalic systems are primarily involved; these are the cases having temporal lobe foci on the one hand, or a 3 c./sec. spike and wave pattern on the other.
   
4. Clear behavioural differences between these two groups can be demonstrated: the temporal focus group shows a high incidence of aggressive manifestations and low neuroticism, while the reverse holds good for the 3 c./sec. spike and wave group (the "petit mal" group).
   
5. These differences are such that they clearly mark off the two groups from a "neutral" sample of cases consisting of non-temporal cortical foci (PCOF group).
   
6. Cases with irregular (generalized) spike and wave have been considered separately from the classical 3 c./sec. spike and wave group. The behavioural correlates of the former are such as to further justify this separation. These children are "average" in aggressivity and only a little more neurotic than the neutral control group. It may be that in a number of these cases both the rhinencephalic and the centrencephalic systems are involved. As these two systems seem to be associated with opposite behavioural features, the resultant picture may be expected to be somewhat indeterminate in character.
   
7. Other EEG groups were studied : those with a diffuse epileptic record, a non-specifically abnormal EEG, and a normal tracing. Of these the diffuse group were the most aggressive and the least neurotic, the normal the reverse, and the non-specifically abnormal in between. However, all the differences were very slight and could well have been due to chance.
   
8. Dividing the sample of epileptic children according to clinical fit pattern and comparing the behavioural features of the different subgroups yielded much less clear-cut a picture. It is clear that such a classification tends to place together cases whose underlying physiological processes are substantially different. 9. Regarding non-aggressive anti-social conduct disturbances the differences between the physiological groups are not so striking, though there is a suggestion that the "petit mal" children are rather "good" compared to temporal lobe children. Larger numbers are required for firm conclusions being drawn in this area of behaviour pathology.
   
9. The present investigation tends to support clinically the experimental evidence on the role of the rhinencephalon in facilitating aggressive behaviour. It is suggested that the findings on the centrencephalic groups lend support to the theory that the spike and wave phenomenon is part of a homeostatic mechanism.
   
10. The proposition that epileptic children with different underlying physiology exhibit different modes of behaviour appears to be strongly confirmed. It is concluded that while the environmental factors determine the presence or absence of behaviour disorders in epileptic children (pathogenic factor), the neurophysiological status determines the type and quality of the reaction (pathoplastic factor).