Epilepsy

It is now clear, after long historical dispute, that a predisposition to epileptic fits does not mean per se that there will be associated intellectual impairment, personality disorder, or mental illness. Most patients with epilepsy remain mentally normal, although this does depend on the presence, site, and extent of any brain damage underlying the epilepsy (89).

However, those patients with epilepsy without significant brain damage do, nonetheless, remain prone to cognitive impairment, particularly memory impairment, as a result of their epilepsy and its treatment. The potential impact of this cognitive impairment must be considered when assessing a patient with epilepsy's fitness for interview.

For example, problems with concentration, memory, and intellectual functioning can be seen when anticonvulsant drugs are administered in toxic doses or unsuitable combinations (90). Suspicion should be raised when a suspect complains of mental lethargy or appears to be performing below expected levels, symptoms particularly associated with toxicity.

Further problems with the reliability of testimony from epileptics may be related to their personality. Patients with epilepsy are often overprotected in childhood by concerned parents and, later in life, can be exposed to pro found social and occupational discrimination (91). All these factors can lead to personality problems, which include feelings of insecurity, low self-esteem, and dependency. Individuals with these personality traits are likely to be highly suggestible and may strive to please interviewing officers by giving answers that seem plausible and consistent with the external cues provided, even though the responses are known to be untrue.

The neurophysiological consequences of an epileptic seizure can seriously distort an individual's perception of events occurring around the time of the seizure, thus rendering any subsequent account of that event potentially unreliable. Complex disturbances of thinking, memory, or awareness may feature as part of an aura preceding the actual seizure. These may include distortion sense of time, mental confusion, or feelings of depersonalization or déjà vu. The seizure may also be ushered in by distorted perceptions or actual hallucinations of sight, hearing, taste, or smell. When the ensuing fit is mild or abortive, the connection between these reported experiences and their epileptic causation may be missed (91).

Typical absences, or petit mal epilepsy, is a disorder that usually starts in childhood, but the attacks can continue into adult life. Absence attacks are brief, with an abrupt onset and termination; several such absences may occur in quick succession, producing significant gaps in memory.

Further cognitive disturbances can follow in the wake of seizures, with clouding of consciousness and disorientation lasting for a few minutes or up to an hour or more, so that recollection for events occurring during the postictal period may also be unreliable (89).

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