If they include a Deja Vu sensation, those are part of Right temporal
lobe (as opposed to left TL)  Seizure Focus. G./

//// [My comments from my File on March 2003] --> Below is article on TLE
that someone posted link to on alt.ep without comment or description. I
printed 1 copy to read.

G.R.  2004-->   NOTE THIS ARTICLE is about 25k Long, but it's all Here
already anyway!!!   It was Posted onto alt.support.epilepsy Last Year March
27, 2003.    I went to try Shorten Parts of the Blank Spaces but it's all
setup in html? or some format that altering the Titles etc. messes up the
Content, so I left it INTACT.  !!!  :-<   )

 I'll look up other general websites tomorrow to cut and paste (that's what
I was searching for when I found *this one.   I THINK this is what you were
looking for wrt.  Temporal Lobe seizures and 'religious auras'.   )  Some
Light Reading !!   G./

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     Medicine
     The Riddle of
     TLE

     A hard-to-diagnose malady
     causing bizarre behavior
     may be curable

     The Atlantic Magazine

     November 1988 - page 30

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    ARTHUR CREW INMAN was a native of Atlanta who, following a physical and
emotional breakdown in 1916, at the age of twenty-one, left college and
retired to a darkened, soundproof suite of apartments in Boston. Bedridden f
or the most part, he was attended by servants, physicians, and strangers
whom he paid to talk to him. An inheritance supported this life-style. He
complained of crippling aches and pains, extreme sensitivity to light and
sound, and despair over the state of the world. Something compelled him to
record these complaints and much more in a personal diary that he kept for
more than forty years. He attempted suicide several times and in 1963
succeeded, after noise from the construction of a skyscraper drove him wild.
He left behind a 155-volume, 17-million-word diary - probably the longest
ever written - which, greatly abridged, was published as The Inman Diary in
1985, in two volumes, by Harvard University Press.

The question is, What was wrong with Inman? Physicians who saw him -
including "thirty-four eminent doctors" who examined him after his
breakdown -concluded unanimously that he had no apparent physical ailment.
Inman, convinced that his difficulties had on organic source, rejected the
medical establishment and resigned himself to the care of osteopaths. But
even his chief osteopath, who is given the name "Dr. Frederick Lakian" in
the published diary, and who treated him for twenty-five years, says,
"Arthur was a hypochondriac. To a great degree, his symptoms were purely
imaginary." Why, then, did he live the way he did? What made him so
susceptible to pain and depression, so driven to write?

A disorder that could explain all of Inman's difficulties does exist. It is
temporal lobe, or temporolimbic, epilepsy (TLE), an often disabling
neurological disorder. TLE is mani-fested by bizarre sensory and somatic
seizures that can be triggered by light and sound. In some patients TLE is
accompanied by hypergraphia, a compulsive urge to write detailed diaries and
poems - and sometimes to draw with similar intensity.

The most common form of epilepsy among adults, TLE is believed to affect
600,000 to a million Americans. Some doctors speculate that if TLE were
properly diagnosed, it might be found to affect one in a hundred adults -
making it an extremely common illness. Like other epilepsies, it is the
result of electrical storms in the brain: abnormal, excessive firing of
neurons in the central nervous system. Epilepsy can be caused by congenital
abnormalities, tumors, viruses, and injuries to the brain, but most cases of
epilepsy are idiopathic: their cause is unknown. Doctors call TLE a complex
partial seizure disorder -"complex" because its seizures usually result in
impairment but not cessation of consciousness, and "partial" because they
involve only part of the brain and body. This terminology distinguishes the
disorder from the better-known grand-mal and petit-mal epilepsies, in which
seizures are "generalized" throughout the brain and cause either
unconsciousness and gross motor convulsions or brief lapses in awareness.

Many historical figures may have had TLE, including such religious and
political leaders as Moses, Mohammed, Julius Caesar, and Alexander the
Great, and such writers as Dostoyevsky, Flaubert, Lewis Carroll, and Eugene
O'Neill. Another possible TLE sufferer is Vincent van Gogh, whose
hypergraphia is well documented. In a fifteen-month period in the late
1880s, for example, van Gogh produced hundreds of paintings, drawings, and
lengthy letters. The conversion of another great writer of letters, the
Apostle Paul, on the road to Damascus, had several of the hallmarks of a
complex partial seizure - a blinding flash of light, confusion, a
disembodied voice, and subsequent loss of appetite.

In a typical complex partial seizure a person stares blankly, smacks his
lips or swallows, performs an automatic motion such as shaking a limb or
picking at clothing, and is thenn bewildered and unable to speak for several
minutes. But variations abound. The brain structures that can be affected by
TLE are so heterogeneous - they control the senses, memory, learning, heart
rate, and blood pressure - that a seizure can be experienced in any number
of ways. Physical changes, such as irregular heartbeat and sexual climax,
can occur. Some patients report intense emotions -fear, for example, that
"something terrible is about to happen," or tremendous, unexplained joy.
Dostoyevsky wrote, "I would not exchange for all the happiness life could
give me the bliss" that preceded his seizures. Others experience a
particular vivid memory every time they had a seizure. Still others enter
into a "dreamy state," in which their emotions and memory are temporarily
shut off. Altered sensory states are common. They include the "Alice in
Wonderland syndrome," in which objects appear shrunken or enlarged; auditory
and visual hallucinations; and "depersonalization" - the feeling of being
outside or above one's body. Some seizures are preceded by pain, nausea, a
foul smell of "burning rubber"or "dead skunk," or a "funny feeling" in the
chest or stomach. Inappropriate laughter or crying may follow seizures. Many
patients sleep for several hours afterward and then feel better.

More even than with most diseases, deciding whether or not someone has TLE
is like doing detective work. To diagnose TLE, doctors look for an apparent
clinical seizure as well as a "spike focus" - a region of the brain where
abnormal electrical discharges begin, detectable on an electroencephalogram
(EEG). TLE seizures are often not recognized for what they are, and large
areas of the temporal lobes are inaccessible to the EEG. So although a
positive EEG during a clinical seizure is the best indicator of TLE, a
negative EEG dos not rule it out. Only in the past ten years have medical
researchers been able to use sophisticated diagnostic tools as EEGs with
electrodes that can be implanted inside the brain or on its surface. These
techniques, however, are expensive and still not widely used. As a result,
many people with TLE (including roughly 30 percent of those with TLE being
treated at the Beth Israel Hospital, in Boston) are first misdiagnosed as
having a psychiatric disorder. The prevalence of psychosis seems much
greater in people with TLE than in the general population, however, for
reasons that are not yet known.

IN INMAN'S CASE, the best evidence is in the diary. The EEG was not invented
until 1929, long after Inman swore off medical science, so he never had one.
His scanty hospital records and autopsy report are unrevealing. But his
description of his 1916 breakdown, which involved bizarre sensory and
emotional states and culminated in an attack while he was at the home of
friends, is consistent with a TLE seizure. "My whole nervous system went on
strike," Inman wrote.

 Specks of light zigzagged in front of me. My ears whistled. . . . Theroom
began to circle with a curious rotary motion, very bewildering. I heard them
talking, asking questions, but my ears were full of noise, and I could not
understand. Suddenly . . . . I began to cry long, racking sobs, with out any
end.
His friends were frightened and tried to put him to bed. After lying down
for a while, Inman was able to join them for dinner.

This was the first of many such attacks. Inman wrote in 1919, "I feel as
though I were undergoing a change such as occurs in a violin string when the
pitch is raised. This condition has occurred to me time after time. . . ."
Thirty years later he wrote,

 I live in a box where the camera shutter is out of order and the filter
doesn't work and the film is oversensitive, and whatever that is beautiful
or lovely by rights registers painfully or askew. . . . The simplest factors
of existence, sunlight and sound, uneven surfaces, moderate distances,
transgress my ineffective barriers and raid the very inner keep of my broken
fortifications, so that there exists no sanctuary or fastness to which I can
withdraw my sensitivity, nether awake nor asleep.
A medical report appended to the published diary suggests that the 1916
breakdown could have resulted from a viral infection, such as
mono-nucleosis. But since no fever was reported, a virus is unlikely.
Inman's sensitivities to light and sound and his visual and auditory
hallucinations suggest migraine headaches as well as TLE. Migraines, thought
to result from the expanding and shrinking of blood vessels to the brain,
are more complex than other headaches. They share symptoms with TLE,
including nausea, numbness, and temporary speech difficulties. Migraines are
much more common among epilepsy sufferers than in the general population,
and have on occasion responded well totreatment with anti-convulsant drugs.
Inman probably had migraines. "But migraines alone could not have accounted
for his unusual personality," says Shahram Khoshbin, a neurologist at
Harvard Medical School and the Brigham and Women's Hospital, in Boston. "TLE
could have."

PEOPLE WITH TLE, according to Khoshbin, tend to demonstrate five interictal
traits (that is, traits in evidence between rather than during seizures).
The first of the traits is hypergraphia. The second is hyperreligiosity - an
unusual degree of concern with morality, philosophy, and mysticism,
sometimes leading to multiple religious conversions. the third is
"stickiness" or clinginess. People with this trait are often reluctant to
end conversations. Doctors say their patients with TLE characteristically
prolong appoint-ments by returning to or repeatedly telephoning their
offices. The fourth trait is altered or decreased interest in sex. The fifth
is aggressiveness - usually undirected and transient, and rarely leading to
violence.

The prevalence of this interictal behavior syndrome in people with TLE is
controversial. No hard figures exist, and estimates vary widely. Some people
with TLE do not have any of the traits. But "a large proportion" of them
have some, according to Spiers, a neuro-psychologist at the Beth Israel.
David Bear, the director of neuropsychiatry at the Vanderbilt University
School of Medicine, agrees that the syndrome "could be very common." Bear
says that he finds the syndrome in "a large percentage" of his TLE patients,
many of whom are referred to him because of his interest in behavior change
and epilepsy. However, Thomas Browne, a neurologist at the Boston University
Medical Center and the Veterans Administartion Medical Center in Boston,
says that in his experience the syndrome occurs in a "minority" of people
with TLE - by his estimate, some five to 30 percent.

Pierre Gloor, a neurologist at the Montreal Neurological Institute, known
throughout the world as a last stop for "untreatable" epilepsy patients,
says that the syndrome may not be apparent unless doctors search for it. "It
hits you in the eye in less than ten percent of cases, but that doesn't mean
it doesn't exist in a somewhat hidden form in some other patients. Sometimes
you have to dig for it."

When the behavior syndrome does occur, it is likely to arise abruptly and
uncharacteristically. Researchers at the Beth Israel report the case of an
athletic instructor with no previous intellectual interests who became
consumed with the idea of writing something important. Another patient
there, "started to keep a minute-by-minute log of his feelings and their
relationship to God." Sexual changes occur just as suddenly. The most common
is the loss of interest in sex, notable because it is not accompanied by
loss of sexual function. Other patients undergo changes in sexual
orientation - for example, alternating between homosexuality and
hetero-sexuality as the frequency of their seizures changes. Though rare,
deviant sexual practices - pederasty, bestiality, and fetishism - have also
been reported. An extreme example of this is a man with TLE who became
sexually aroused only at the sight of a safety pin, an involuntary response
that must have resulted from faulty wiring in the brain.

THE NEUROLOGICAL mechanism underlying the behavior syndrome is not clearly
understood. The late Norman Geschwind, a renowned behavioral neurologist at
Harvard, Hypothesized that the syndrome occurs not as result of seizures but
rather as a consequence of changes in the brain which can themselves cause
seizures. Too many and too rapid electrical connections in the brain's
temporolimbic structures may bring about behavior changes. David Bear call
these brain structures "gatekeepers to consciousness," for inthem the
sensory world meets our emotions and relates our sensory experience to
biological drives (aggression, fear, hunger, and sexuality). If the
structures are damaged, these connections can be altered. producing what
Geschwind called "an excessive investment of the environment with limbic
signifi-cance." As a result,

 external stimuli begin to take on great importance; this leads in turn to
increased concern with philosophical, religious, and cosmic matters. Since
all events become charged with importance, the patients frequently resort to
recording them in written form at great length and in highly charged
language.
Many neurologists, however, consider the behavior syndrome questionable -and
even pernicious - as a diagnostic category. Robert Feldman, the chief of
neurology at the Boston University Medical Center and the Veterans
Administration Medical Center in Boston, says that although some patients
with TLE "do eshibit these personality traits, serious questions still exist
about how specific they are" for TLE. Feldman speculates that the syndrome
results not from neurological changes in the brain, as Geschwind proposed,
but from the psychological and social stresses that all epilepsy sufferers
experience. Seizures often "interfere with interpretation of environmental
cues," he says, adding that people whose seizure disorders began in
childhood tend to have the greatest social maladaptation. But the
neurologist Martin Albert, also of the Boston University and Boston VA
medical centers, is not convinced that the behavior syndrome is entirely the
result of external factors. "Children with serious chronic illnesses other
that epilepsy are also excluded and stigmatized," he says. "Why don't they
develop this cluster of traits?"

Many people resist the notion that abnormally firing neurons can
alterbehavior and emotions. As Paul Spiers explains this resistance, "Who
wants to think that a great literary work is based on a disease?" Some
doctors, ackowledging the long history of prejudice against people with
epilepsy, oppose publicly linking certain personality traits with TLE. That
association, according to Thomas Browne, puts an additional and unnecessary
burden on people who "already have enough trouble getting along in society."
David Coulter, the chief of pediatric neurology at the Boston University
School of Medicine, says, "The behavior syndrome is a personality disorder,
a cluster of pejorative attributes, and gives people with epilepsy a bad
name."

But doctors may do their patients a greater disservice by denying that
behavior syndrome is related to TLE. "The fact is that patients who have
these symptoms go around wondering, 'Am I crazy?'" Paul Spiers says. "We can
say, 'No, you're not crazy.'" Bear emphasizes that the syndrome represents a
behavioral change, not a disease. Many of its traits, such as an interest in
cosmic issues or a tendency to write extensively, are not in themselves
signs of sickness. Dostoyevsky may have written as much and as well as he
did because of epilepsy. Spiers says. "One of my TLE patients is a published
poet who says that when her seizures are under control, the muse leaves
her."

As for Inman, clearly he had many, if not all, of the traits of the behavior
syndrome. On a questionnaire designed by Bear and the psychologist Paul
Fedio, of the National Institutes of Health, to determine the extent to
which the syndrome is present in patients, Inman scores well within the
range of people with TLE and substantially above the control groups. The
questionnaire was filled out for Inman separately by Bear and by Libby
Smith, one of the editors of The Inman Diary. Smith, who spent seven years
reviewing the unabridged diary andinterviewing scores of people who knew its
author, had never heard of TLE. Both she and Bear gave Inman high marks in
nearly all of the eighteen traits listed on the question-naire. (Together
these eighteen make up a personality pattern quite similar to that described
by Khoshbin's five traits.) "Compulsive attention to detail," for example,
describes Inman's need to make lists and keep to rigid schedules. His
childlike charm and tendency to fly into rages translate into high scores in
several categories: "dependence," "deepening of all emotions,"
"humorlessness," and "paranoia." And his effort to chronicle his era
demonstrates his "grandiosity" and "sense of personal destiny."

The syndrome could explain many of Inman's peculiarities - which bewildered
his diary's readers. A story recounted by his chief osteopath reads like a
textbook definition of stickiness. "I would be sailing off Cape Cod," Lakian
recalls.

 The Coast Guard cutter would come up. They'd say they had just had a flash
that Arthur Inman wanted to see me immediately. I'd have to call him,
ship-to-shore, and tell him I couldn't come right away. He'd say, "You have
to come." I'd tell him it would cost him a lot of money. He'd say, "I don't
care. Just come."
Lakian's description of Inman's sexual behavior fits the syndrome equally
well. "Often when I came to see him, he would be sitting in a rocking chair,
with these kids - young girls - in his lap, fondling them, his hands up
their legs."

Sex held a somewhat intellectual fascination for Inman. He liked to lie
naked in bed with women. He begged them to describe their sexual feelings to
him. But he disliked sexual intercourse, and rarely engaged in it. Even if
Inman didn't have epilepsy, "he must have had some kind of temporal-lobe or
limbic disorder," according to Paul Spiers. "He was both detached and
intense - in some sense not emotionally connected to the world."

Experts caution that the presence of the interictal behavior syndrome is not
sufficient grounds for a diagnosis of TLE. But when the syndrome is present,
epilepsy may reasonably be considered. Other possible causes of these traits
are repeated use of LSD or cocaine, severe depression, and manic-depressive
illness.

IF INMAN DID have TLE and were alive today, he would probably be treated
with anticonvulsant medications and supportive psychotherapy and perhaps
surgery. Although Inman was never suspected of having epilepsy, he was in
fact addicted to two drugs originally used as anticonvulsants - potassium
bromide, first used for this purpose in 1859 and now largely discontinued,
and barbiturates, introduced early in this century and still regarded as
effective. The most common anticonvulsant drugs used today for TLE are
carbamazepine, phenytoin, and phenobarbital. These may eliminate seizures or
significantly reduce their frequency and severity in some patients, but have
not been shown to affect interictal behavior and do not adequately control
seizures for many people with TLE - 25 percent of them according to doctors,
and roughly 65 percent according to the patients themselves.

After exhaustive two-year surgical work-ups, a small number of TLE patients
undergo surgery to remove the part of the brain containing the seizure
focus - often a mass of tissue as large as a fist. This operation has been
performed, in conjunction with the EEG, on more than 5,000 patients since
1939, and far fewer than one percent have died as a result, largely because
patients are not anesthetized during the procedure. Roughly 40 percent of
survivors have become seizure-free and able to go off anti-convulsants.
Another 40 percent have had significantly fewer seizures while remaining on
drugs, and roughly 20 percent have remained the same or worsened. Worsening
usually meansmore-frequent seizures and the introduction of new kinds of
seizures, and rarely it involves lasting difficulties with thinking and
remembering. Remarkably, however, a common long-term aftereffect of the
surgery is improved neurological functioning overall; many patients' IQs
have actually increased, and their moods have heightened. This is probably
because epileptic brain tissue interferes with normal brain function.

TLE and the interictal behavior syndrome no doubt deserve much more
attention and research. Because the disorder crosses the traditional
boundaries between psychiatry and neurology, improved methods of recognizing
and treating it may lead to a revolution in the diagnosis and treatment of
psychiatric disorders such as manic-depressive illness and schizophrenia.
Indeed, some doctors now suspect that many psychiatric disorders are
themselves somehow related to seizures. Not long before his death, in 1984,
Norman Geschwind wrote,

 Behavioral change in temporal lobe epilepsy deserves very special
consideration, since it is probably the only cause of major change in
behavior for which we have a plausible mechanism of pathogenesis. . . . The
importance of this syndrome results from its clinical fascination, its
frequency, and from its unique capacity to present to us a clear-cut
physiological paradigm for the occurrence of behavioral change after
alterations in the brain.
TLE, which permits psychiatrists and neurologists to examine the same
problems, may advance knowledge in both fields and lead to a better
understanding of the physiological causes of mental illness and mental
health.

- Eve LaPlante

i read that Joan of Arc was possibly shizophrenic. i wonder if schizophrenia
is involved with the TL.

Interesting discussion...
I am in my 40's, and over a period of months last year, suffered a
number of seizures. I'm taking medication now, and the seizures have
been under control now for about 8 months, but one thing that I felt
very strongly over that period was an acute feeling of religious
consciousness. I felt that without any doubt, I knew what God was,
what man's place in the cosmos really meant, and how the Great
Religions of the world stumbled in attempting to describe the
spiritual message. In all, a strange situation for someone with no
religious background.
I kept this to myself (mostly), but imagine my surprise, when,
watching "Nova" on PBS last week, a program regarding the brain
described this as a quite common phenomenon for persons with temporal
lobe epilepsy.
I'm now quite interested in finding out if this was a (very
real-feeling) type of hallucination, or if this electrical
short-circuiting allowed me for a time, a better insight into what
everyone has, but can't fully access.
In many ways, I feel embarrassed writing this, as I know how crazy
this can seem, but I'm pretty normal...I don't do drugs, am university
educated, and am an Air Force Officer.