Aggression in Epilepsy

Cerebral dysfunction can cause distorted perception and instigate aggression. However, previous research has shown inconsistent findings on the link between aggression and epilepsy. Critical neuroanatomical structures, such as the amygdala, hippocampus, and frontal lobe, play vital roles in controlling aggression. The neurotransmitter serotonin, linked to impulsive and aggressive behaviors, could disrupt behavioral control when its levels are reduced. Furthermore, seizures might impact the amygdala, contributing to fear conditioning and aggression vulnerability. Depending on the chronological relationship with seizures, aggression in people living with epilepsy (PLWE) can be categorized as preictal, ictal, postictal, and interictal. Societal biases associating aggression with epilepsy can heighten stigma, reducing the quality of life for PLWE. A comprehensive evaluation of medical history, symptoms, and coexisting psychiatric conditions is necessary to understand and manage PLWE aggression. Drugs such as beta-blockers, atypical antipsychotics, and phenytoin along with behavioral management strategies can help mitigate aggression in PLWE. Optimizing antiseizure medications (ASMs), mainly using mood-stabilizing ASMs, are also essential. If aggression is induced by an ASM, reducing dosage, discontinuing, or substituting the drug may be needed. Using a proper questionnaire can help assess aggression levels. Treating any comorbid psychiatric disorders is also crucial to reducing aggression in PLWE.