Skip to main content
SpringerLink
Log in

Posttraumatic Seizures in Survivors of Torture: Manifestations, Diagnosis, and Treatment

  • Published:
Journal of Immigrant Health Aims and scope Submit manuscript

Abstract

Survivors of torture are very likely to have been beaten repeatedly around the head. Apparent brief losses of consciousness are not uncommon following torture, and they may be associated with signs that suggest temporal lobe epilepsy (TLE). The relative risk of developing posttraumatic seizures (PTS) is increased by about 50% after a single head injury involving a brief loss of consciousness. It is 2.9 if that loss of consciousness lasts for more than about 30 min. Thus, patients who have been tortured are at increased risk of seizures. TLE is difficult to diagnose and needs specialist investigations, and other conditions that are not uncommon in survivors of torture, such as panic attacks, posttraumatic stress disorder, dissociation, and syncope can all present with similar pictures. This paper addresses the differential diagnosis of posttraumatic epilepsy in survivors of torture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Moreno A, Grodin MA: Torture and its neurological sequelae. Spinal Cord 2002; 40:213–223

    Google Scholar 

  2. Rasmussen O: Medical aspects of torture. Danish Med Bull 1990; 37(Suppl 1):1-88

    Google Scholar 

  3. Begovac J, Jeren T, Kuzman I, Jukic V, Ravlic Z, Andrasevic S: Health status of 1458 Croatian prisoners of war, 1991-1992. JAMA 1993; 270:574–575

    Google Scholar 

  4. United Nations High Commissioner for Refugees: 2001UN-HCR population statistics (Provisional). Retrieved July 14, 2003, from http://www.unhcr.ch/cgi-bin/texis/vtx/statistics

  5. United Nations High Commissioner for Refugees: Asylum trends in industrialized countries, May 2003. Retrieved July 14, 2003, from http://www.unhcr.ch/cgi-bin/texis/vtx/ statistics

  6. Brenner J: Human rights education in public health graduate schools: 1996 survey. Health Human Rights 1996; 2(1):129–139

    Google Scholar 

  7. Rafuse J: Multicultural medicine: "Dealing with a population you weren't quite prepared for." Can Med Assoc J 1993; 148(2):282–285

    Google Scholar 

  8. Sonis J, Gorenflo DW, Jha P, Williams C: Teaching human rights in US medical schools. JAMA 1996; 276(20):1670–1678

    Google Scholar 

  9. Ko DY, Sahai S: Temporal lobe epilepsy. E-Medicine. October 19, 2001. Retrieved July 1, 2003, from www. emedicine.com/NEURO/topic365.htm

  10. Chadwick D: Seizures and epilepsy after traumatic brain injury. Lancet 2000; 355:334–335

    Google Scholar 

  11. Sawhney IMS, Singh A, Kaur P, Suri G, Chopra JS: A case control study and one year follow-up of registered epilepsy cases in a resettlement colony of North India, a developing tropical country. J Neurol Sci 1999; 165:31–35

    Google Scholar 

  12. Valencia M, Valencia P: Etiology of the epileptic seizures in Recife City, Brazil: Study of 249 patients. Arquivos de Neuro-Psiquiatria 2000; 58:1064–1072

    Google Scholar 

  13. Brain Injury Special Interest Group-American Academy of Physical Medicine and Rehabilitation: Practice parameter: Antiepileptic drug treatment of posttraumatic seizures. Arch Phys Med Rehabil 1998; 79:594–597

    Google Scholar 

  14. Dugan EM, Howell JM: Posttraumatic seizures. Emerg Med Clin North Am 1994; 12(4):1081–1087

    Google Scholar 

  15. Iudice A, Murri L: Pharmacological prophylaxis of posttramatic epilepsy. Drugs 2000; 59:1091–1099

    Google Scholar 

  16. Willmore JL: Posttraumatic seizures. Neurol Clin 1993; 11(4):823–834

    Google Scholar 

  17. Annegers JF, Hauser WA, Coan SP, Rocca WA: A population-based study of seizures after traumatic brain injuries. NEJM 1998; 338:20–24

    Google Scholar 

  18. Riquelme HU: EsLa practica de la medicina bajo la influencia de la dominacion totalitaria. Entre la obediencia y la oposicion-Los medicos y la etica profesional bajo la dictadura. Caracas: Editorial Nueva Sociedad; 1995:43–145

    Google Scholar 

  19. Wheless JW, Kim HL: Adolescent seizures and epilepsy syndromes. Epilepsia 2002; 43(Suppl 3):33–52

    Google Scholar 

  20. Ahern GL, Howard GF, Weiss KL: Posttraumatic pilo-motor seizures: A case report. Epilepsia 1998; 29(5):640–643

    Google Scholar 

  21. Blumer D: Evidence supporting the temporal lobe epilepsy personality syndrome. Neurology 1999; 53(5):S9–S12

    Google Scholar 

  22. Devinsky O, Naijar S: Evidence against the existence of a temporal lobe epilepsy personality syndrome. Neurology 1999; 53(5):S13–S25

    Google Scholar 

  23. Alemayehu S, Bergey GK, Barry E, Krumholz A, Wolf A, Fleming CP, Frear EJ: Panic attacks as ictal manifestation of parietal lobe seizures. Epilepsia 1995; 36:824–830

    Google Scholar 

  24. Chadwick D: Not everything that jerks is epilepsy. Br J Sports 1997; 31:173

    Google Scholar 

  25. Stephenson JB: Fits and Faints. Oxford: MacKeith Press; 1990:41–42

    Google Scholar 

  26. McCrory PR, Berkovic SF: Concussive convulsions-Incidence in sport and treatment recommendations. Sports Med 1998; 25(2):131–136

    Google Scholar 

  27. Foster DW, Rubenstein AH: Hypoglycemia: In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL, eds. Harrison's Principles of Internal Medicine, 13 edn. New York: McGraw-Hill; 2000:2006

    Google Scholar 

  28. Chadwick D, Smith D: The misdiagnosis of epilepsy. BMJ 2002; 324:495–496

    Google Scholar 

  29. Rosenberg HJ, Rosenberg SD, Williamson PD, Wolford GL: A comparative study of trauma and posttraumatic stress disorder prevalences in epilepsy patients and psychogenic nonepileptic patients. Epilepsia 2000; 41:337–452

    Google Scholar 

  30. Fleisher W, Staley D, Krawetz P, Pillay N, Arnett JL, Maher J: Comparative study of trauma-related phenomena in subjects with pseudoseizures and subjects with epilepsy. Am J Psychiatry 2002; 159:660–663

    Google Scholar 

  31. Sackarelles DK, Sackarelles JC: Impaired motor function in patients with pseudoseizures. Epilepsia 2001; 42:1600–1606

    Google Scholar 

  32. Coons PM: The dissociative disorders, rarely considered and underdiagnosed. Psychiatr Clin North Am 1998; 21:637–648

    Google Scholar 

  33. Kuyk J, Spinhoven P, van Emde Boas W, van Dyck R: Dissociation in temporal lobe epilepsy and pseudo-epileptic seizure patients. J Nerv Ment Dis 1999; 187:713–720

    Google Scholar 

  34. Jacobs UVI: Torture and its consequences: A challenge to clinical neuropsychology. Prof Psychol Res Pract 2001; 32(5):458–464

    Google Scholar 

  35. Moreno A, Grodin MA: The not-so-silent marks of torture. JAMA 2000; 284(5):538

    Google Scholar 

  36. Physicians' Desk Reference, 57th edn. Montvale, NJ: Medical Economics Company; 2003

  37. Patsalides BH, Moreno A, Liebschutz JM: Immigrants, refugees, and survivors of torture: In: Liebschutz JM, Frayne SM, Saxe GN, eds. Violence Against Women-A Physician's Guide to Identification and Management. Philadelphia, PA: American College of Physicians; 2003:225–250

    Google Scholar 

  38. American Psychiatric Association: Outline for cultural formulation and glossary of culture-bound syndromes: In: Di-agnostic Statistical Manual of Mental Disorders (DSM IV-TR). Washington, DC: American Psychiatric Association; 2000:897–903

    Google Scholar 

  39. Epilepsy Foundation: Driver Information by State. Retrieved July 01, 2002, from http://www.epilepsyfoundation.org/ answerplace/Social/driving/statedrivinglaws.cfm

  40. Kitson A, Shorvon S: Clinical Standards Advisory Group. Services for Patients With Epilepsy. London, UK: Department of Public Health; 2000

    Google Scholar 

  41. Pedley TA: The epilepsies: In: Goldman L, Bennett JC, eds. Cecil Textbook of Medicine, 21st edn. Philadelphia, PA: WB Saunders; 2000:2151–2163

    Google Scholar 

  42. Wieshmann UC, Free SL, Everitt AD, Barlett PA, Barker EJ, Tofts PS: Magnetic resonance imaging in epilepsy with a fast FLAIR sequence. J Neurol Neursurg Psychiatry 1996; 61(4):357–361

    Google Scholar 

  43. Jack CR, Rydberg CH, Krecke KN: Mesial temporal sclerosis: Diagnosis with fluid attenuated inversion-recovery versus spin-echo MRI imaging. Radiology 1996; 2:367–373

    Google Scholar 

  44. Thompson SA, Duncan JS, Smith SJ: Partial seizures presenting as panic attacks. BMJ 2000; 321:1002–1003

    Google Scholar 

  45. Pataraia E, Lindinger G, Deecke L, Baumgartner C: MEG evaluation in temporal lobe epilepsy. Retrieved from July 01, 2003, from 'www.ctf.com/papers/pataraia Biomag00 1.pdf <http://www.ctf.com/papers/pataraia Biomag'00 1.pdf>.

  46. Hernandez TD, Naritoku DK: Seizures, epilepsy, and functional recovery after traumatic brain injury: A reappraisal. Neurology 1997; 48:803–806

    Google Scholar 

  47. Chatham-Showalker PE, Kimmel DN: Stimulating consciousness and cognition following severe brain injury: A new potential clinical use for lamotrigine. Brain Injury 2000; 14(11):997–1001

    Google Scholar 

  48. Iacopino V, Ozkalipci O, Schlar C: The manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment (the Istanbul Protocol). Retrieved from http://www.unhchr.ch/html/menu6/2/training.htm

  49. Teasdale G, Jennett B: Assessment of coma and impaired consciousness: A practical scale. Lancet 1974; 2:81–84

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Austin Medical Education Programs at Brackenridge Hospital, Austin, Texas

    Alejandro Moreno

  2. The Boston Center for Refugee Health and Human Rights at Boston Medical Center, Boston, Massachusetts

    Alejandro Moreno

  3. The Health Law Department, Boston University School of Public Health, Boston, Massachusetts

    Alejandro Moreno

  4. The Medical Foundation for the Care of Victims of Torture, London, United Kingdom

    Michael Peel

Authors
  1. Alejandro Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Peel
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moreno, A., Peel, M. Posttraumatic Seizures in Survivors of Torture: Manifestations, Diagnosis, and Treatment. Journal of Immigrant Health 6, 179–186 (2004). https://doi.org/10.1023/B:JOIH.0000045255.64395.d1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:JOIH.0000045255.64395.d1

Search

Navigation