The biting behavior (BB) and other aggressive gestures in a group of 11 patients (8 male; 3 female) with drug-resistant seizures were studied in presurgical evaluations using video-EEG/SEEG monitoring at University of Bologna; Niguarda Hospital, Milan; and University of Modena, Italy. Seizure onset was at age 1 to 21, and age at evaluation was 30-59 years. BB was reflexive, occurring during or after a seizure, and evoked by intrusion of the examiner’s hand near the patient’s face. The act was associated with emotional arousal, fear, or anger, and was accompanied by aggressive gestures. The EEG showed that BB was localized to ictal involvement of the amygdala/hippocampal and the orbitomedial prefrontal regions. [1]

COMMENT. This study concerned adults whose seizures began in childhood. The authors emphasize that violence is exceptional during epileptic seizures, and distinct from that reported with postictal psychosis. The diagnosis requires EEG confirmation during BB. In children with ADHD and comorbid oppositional defiance disorder, biting and aggressive tendencies are not uncommon, and abnormal EEGs have been reported with ADHD in 15% of cases (Hemmer SA, Pasternak JK et al, 2001; Ped Neur Briefs May 2003). A video-EEG is necessary to relate BB to ictal activity, as a prelude to a trial of antiepileptic medication. Several studies have linked behavioral abnormalities to epilepsy in childhood, but the indications for antiepileptic treatment are controversial (Boone KB et al, 1988; [Ped Neur Briefs April 1988]; Austin JK et al, 1992; [Ped Neur Briefs Jan 1993]; Wakai S et al, 1994 [Ped Neur Briefs Nov 1994]; Amir N et al, 1994 [Ped Neur Briefs Dec 1994]).