Epilepsy

According to Simonton (1999), Cesare Lombroso—in his classic book, The Man of Genius, which was published in 1891—claimed that genius was often associated with epilepsy. There have been many creative writers who have been presumed to be epileptic, including Machado de Assis (1839-1908), who is considered one of Brazil's most important writers, and Gustave Flaubert (1821-1880), the famous French novelist who is perhaps best known for his Madame Bovary. Flaubert, like other authors with epilepsy, was thought to have left temporal lobe epilepsy. Edgar Allen Poe wrote about episodes of unconsciousness and confusion. Although most people thought that these episodes were induced by substance abuse, including alcohol and drugs, Bazil (1999) suggested that Poe might have suffered with complex partial seizures, a form of localized epilepsy.

In our hospital, we had a patient who was epileptic but who was mistaken as a person who abused drugs. This patient had a partial complex seizure disorder that was difficult to control and thus was being evaluated at our medical center. After he had anticonvulsant blood levels drawn, and before he had a chance to see his physician, he went to the bathroom. Another patient who was being seen by the cardiologists also walked into this bathroom after our patient entered. He noticed that this epileptic man appeared to be confused and disoriented. After the cardiology patient left the bathroom, he called the police. The police came to the bathroom and noticed that not only was the patient confused but he also had several puncture wounds in his arms. Not knowing that he just had blood drawn for hydantoin (Dilantin) levels and that the intern who attempted to draw his blood had a difficult time entering a vein to get his blood, the police thought that he had just injected himself with a narcotic and, therefore, arrested him. His wife was in the doctor's office waiting for him to return from the bathroom. When he did not return in about 15 or 20 minutes, she decided that something was wrong and thought that he either had had a seizure or was lost. She went to the bathroom, opened the door, and called inside. There was no response, and so she asked a man in the hallway to look in the bathroom for her husband. This man looked in the bathroom but reported to the wife that the bathroom was empty. She then walked around the halls looking for him. Finally, she went down to see the health center police and asked them if they knew anything about the whereabouts of her husband. When she described him and told them why he was here, the police realized they had made a terrible mistake and retrieved him from the Gainesville police headquarters. This episode occurred just a few years ago, but Bazil (1999) noted that at the time Poe lived, little was known about complex partial seizures, and with the knowledge that these types of mistakes are made now in modern hospitals, by trained police, there is a good possibility that episodes of unconsciousness and confusion experienced by Poe might have been related to seizures rather than drugs.

Another well-known creative writer who was thought to have epilepsy is Fyodor Dostoevsky. His epileptic seizures appeared to begin in childhood and lasted his entire life (Kiloh, 1986). Because he had aura followed by convulsions, he possibly also had complex partial seizures with secondary generalization. In addition to having bouts of depression, which might have been related to his epilepsy (see below), he also had many other mental disorders. For example, he was very compulsive and also had severe hypochondriasis, which gave the psychoanalysts such as Sigmund Freud an opportunity to explain Dostoevsky's creativity by using psychodynamic mechanisms. Dostoevsky, however, had a progressive memory impairment, and it is unclear how psychodynamic mechanisms can account for this progressive disorder. The medial part of the temporal lobe, which contains structures such as the hippocampus (see Figure 7.1), is very important for storing verbal memories. One of the most common areas of the brain for seizures to occur, is in the medial and anterior temporal lobe. These seizures can cause cell (neuronal) death and scarring. Hence, patients with epilepsy who have seizures that start in the left medial temporal lobe often have an impairment of verbal memory.

Corpus Callosum

Cingulate Gyrus

Cingulate Gyrus

-Retrosplenial Cortex

Mamillary Body

Fornix

Thalamus

Figure 7.1. Diagram of the medial temporal lobe, which includes the hippocampus critical for forming new declarative memories (what, when, and who).

-Retrosplenial Cortex

Mamillary Body

Fornix

Hippocampus Amygdala —

Parahippocampal Gyrus

Thalamus

Figure 7.1. Diagram of the medial temporal lobe, which includes the hippocampus critical for forming new declarative memories (what, when, and who).

Trimble (2000) wrote about the epileptic poet Charles Lloyd and noted that Lloyd also had bipolar disorder. Trimble suggested that the epilepsy was probably destructive to the creative writing process. Thus, although the observation that several creative writers had epilepsy might suggest that there is a relationship between epilepsy and creative writing, epilepsy is a common disorder and to my knowledge no one has formally attempted to learn if there is a significant relationship between this disorder and creativity.

Intelligence is not directly related to creativity, but as mentioned previously, there is a threshold, and a person has to be relatively intelligent to be a successful author. Many people who have chronic complex partial seizures have IQs that are below average, and if investigators performed a study that compared the percentage of successful writers who are epileptic versus the percentage of successful writers who are not epileptic, the success rate might very well be lower in the epileptics. Thus, this study would have to be adjusted for intelligence, and this adjustment would make the study very difficult to perform. If we assume, however, that there is a relationship between epilepsy (i.e., complex partial seizures) and creative writing, how could the presence of this neurological disorder account for this relationship?

Many of the creative epileptics such as Dostoevsky had bouts of depression. Devinsky and Vazquez (1993) studied mood disorders in epileptic patients and found that depression was commonly associated with this disorder. Paradiso and coworkers (2001) found that 34% of patients with temporal lobe epilepsy were depressed, and those with seizures that start in their left temporal lobe, which several of these famous authors appeared to have, were more likely to be depressed than those with right temporal lobe epilepsy. As I mentioned, and will further mention, people with affective disorders have a propensity for creativity. There is, however, another possible relationship. Norman Geschwind (1979) noted that many of his patients with complex partial seizures and especially those that started in the left temporal lobe often wrote copious notes. On the basis of his clinical impression, he wondered if patients with seizures that emanate from the left temporal lobe had what he termed "hypergraphia." Sachdev and Waxman (1981) studied the writing habits of people who had temporal lobe epilepsy (complex partial seizures) and compared them to matched controls. These investigators found a much higher incidence of hyper-graphia in the epileptic population. Geschwind (1979) also noted that patients with complex partial seizures and especially those that emanate from the left temporal lobe appeared to have a "deepening" of cognitive and emotional responses. The combination of an increased propensity to write, mood disorders, and a deepening of emotional experience might lead to an increase in the probability that an intelligent person with complex partial seizures (temporal lobe epilepsy) might turn out to be a creative writer. The reason that temporal lobe epilepsy induces hypergraphia, a deepening of emotions, and an increased incidence of depression, is unknown. It is possible that any chronic affliction that has a continuing social stigma, is intermittent as well as unpredictable and is a major cause of disability that can cause or produce symptoms such as depression and a deepening of emotions. This explanation, however, cannot account for the observation that these changes are associated only with some forms of epilepsy. This explanation also does not account for the hypergraphia. Thus, until further hypothesis-driven research is performed, these relationships remain unexplained.

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