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Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case

In this case study, we present a 21 years old female with long-standing Temporal Lobe Epilepsy (TLE) who, following a sexual assault, also developed Posttraumatic Stress Disorder (PTSD), leading to a change in her seizure semiology. The new seizures seemed to be a re-enactment of the sexual assault...

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Autores principales: Biran, Iftah, Admon, Roee, Gazit, Tomer, Fahoum, Firas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326076/
https://www.ncbi.nlm.nih.gov/pubmed/32670129
http://dx.doi.org/10.3389/fpsyg.2020.01010
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author Biran, Iftah
Admon, Roee
Gazit, Tomer
Fahoum, Firas
author_facet Biran, Iftah
Admon, Roee
Gazit, Tomer
Fahoum, Firas
author_sort Biran, Iftah
collection PubMed
description In this case study, we present a 21 years old female with long-standing Temporal Lobe Epilepsy (TLE) who, following a sexual assault, also developed Posttraumatic Stress Disorder (PTSD), leading to a change in her seizure semiology. The new seizures seemed to be a re-enactment of the sexual assault and accordingly were at first thought to be Psychogenic Non-Epileptic Seizures (PNES). Nevertheless, electroencephalography (EEG) recording at the Epilepsy Monitoring Unit (EMU) revealed ictal epileptic brain activity during these new attacks. In order to further explore the nature of the relation between epileptic seizures and PTSD symptomatology, a functional MRI (fMRI) scan was conducted focusing on neural response to threat (fearful faces). The results indicated that the response to threat elicited bilateral amygdala activation, as well as enhanced amygdala connectivity with the insula and anterior cingulate cortex (ACC), all central nodes of the fear circuitry. Accordingly, we suggest that this unique presentation of “pseudo” PNES might stem from the anatomical proximity of the epileptic network in this patient (temporal-insular-frontal) to the fear circuitry, allowing abnormal epileptic activity to “exploit” or activate the fear circuit or vice versa. We further propose that the traumatic experience may have changed the patient’s ictal semiology by modifying the course of the spread of the ictal activity toward the PTSD network.
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spelling pubmed-73260762020-07-14 Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case Biran, Iftah Admon, Roee Gazit, Tomer Fahoum, Firas Front Psychol Psychology In this case study, we present a 21 years old female with long-standing Temporal Lobe Epilepsy (TLE) who, following a sexual assault, also developed Posttraumatic Stress Disorder (PTSD), leading to a change in her seizure semiology. The new seizures seemed to be a re-enactment of the sexual assault and accordingly were at first thought to be Psychogenic Non-Epileptic Seizures (PNES). Nevertheless, electroencephalography (EEG) recording at the Epilepsy Monitoring Unit (EMU) revealed ictal epileptic brain activity during these new attacks. In order to further explore the nature of the relation between epileptic seizures and PTSD symptomatology, a functional MRI (fMRI) scan was conducted focusing on neural response to threat (fearful faces). The results indicated that the response to threat elicited bilateral amygdala activation, as well as enhanced amygdala connectivity with the insula and anterior cingulate cortex (ACC), all central nodes of the fear circuitry. Accordingly, we suggest that this unique presentation of “pseudo” PNES might stem from the anatomical proximity of the epileptic network in this patient (temporal-insular-frontal) to the fear circuitry, allowing abnormal epileptic activity to “exploit” or activate the fear circuit or vice versa. We further propose that the traumatic experience may have changed the patient’s ictal semiology by modifying the course of the spread of the ictal activity toward the PTSD network. Frontiers Media S.A. 2020-05-20 /pmc/articles/PMC7326076/ /pubmed/32670129 http://dx.doi.org/10.3389/fpsyg.2020.01010 Text en Copyright © 2020 Biran, Admon, Gazit and Fahoum. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychology
Biran, Iftah
Admon, Roee
Gazit, Tomer
Fahoum, Firas
Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case
title Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case
title_full Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case
title_fullStr Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case
title_full_unstemmed Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case
title_short Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case
title_sort interaction of temporal lobe epilepsy and posttraumatic stress disorder: network analysis of a single case
topic Psychology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326076/
https://www.ncbi.nlm.nih.gov/pubmed/32670129
http://dx.doi.org/10.3389/fpsyg.2020.01010
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