Subacute postictal aggression.
OBJECTIVE: To address clinical features of subacute postictal aggression, we examined aggressive behavior beginning hours to days after the acute confusional postictal period. METHODS: Six patients from our database of 1300 were assessed. Data was obtained from the patients, their family and caretakers, and medical records. One patient was studied with closed circuit video/EEG. RESULTS: There is clinical heterogeneity among these individuals with respect to etiology of epilepsy, age of onset, laterality, memory of adverse behaviors, and presence of psychosis. Several clinical features, including male gender, were common to all. The episodes of postictal aggression were not isolated events, but recurred repeatedly; the behaviors were uniquely stereotyped in each patient. Subacute postictal aggression was more likely after a cluster of seizures than after a single ictus. All patients had medically intractable epilepsy and were remorseful in the interictal period. CONCLUSIONS: Subacute postictal aggression, a rare phenomenon within the broad spectrum of epilepsy-related behaviors, appears to be a true clinical entity with several consistently observed manifestations.