Temporal lobe “spike focus” associated with confusion, complete amnesia and fugues in a paranoid schizophrenic

Summary

An unusual case is reported of a man who had no history of difficulties at birth, head trauma, brain infection, febrile convulsions, genetic disposition or undue schizoid traits but suddenly developed at the age of 27 a paranoid psychosis which necessitated hospitalization. Examined over a 10-year period by many experienced psychiatrists in three different hospitals, he was labeled a paranoid schizophrenic. A decade later while in a hospital he experienced a fugue episode, his second, associated with severe confusion, complete amnesia and an EEG spike focus in the left temporal area which established the diagnosis of temporal lobe epilepsy. His first fugue episode almost a year earlier was over-looked as a temporal lobe automatism due to the prominence of mental symptoms of many years' duration. The pathogenesis and the relationship between the late onset of epilepsy in temporal lobe cases, complete amnesia, and mental symptomatology are discussed. A point of interest is not only a flare-up of acute psychotic manifestations each time phenobarbital and Dilantin were instituted, but also a precipitation of seizures following phenobarbital therapy for a three-week period. The dramatic change twice observed with chlorpromazine and trifluoperazine, without untoward influence or convulsive activity, must not be overlooked.

Since only a single case has been presented, the findings and conclusions in this study should be regarded as solitary and tentative.