Emotional experiences as a result of seizure, while less common, may be dramatic—fear, anxiety, sadness, anger, happiness, ecstasy, and sexual excitement have all been recorded. Fear and anxiety are the most common affective experiences, while occasionally the patient describes a feeling of rage or intense anger as part of a temporal lobe seizure.
Each of these subjective psychic states may constitute the entire seizure or some combination may occur and immediately precedes a period of altered awareness. These “auras” represent electrical seizures as already mentioned and have the same localizing significance as motor convulsions do for the frontal cortex. All the temporal lobe ictal experiences have no apparent connection to objective circumstances and are generally not related to the situation in which the patient finds himself during the seizure.
The motor components of a focal temporal lobe or limbic seizure, if they occur, arise during the later phase of the seizure and take the form of automatisms such as lip-smacking, chewing or swallowing movements, salivation, fumbling of the hands, or shuffling of the feet. Patients may walk around in a daze or act inappropriately. Complex acts that were initiated before the loss of consciousness—such as walking, chewing food, turning the pages of a book, or even driving—may continue. However, when asked a specific question or given a command, the patients are obviously out of contact with their surroundings. There may be no response at all, or the patient may look toward the examiner in a perplexed way or utter a few stereotyped phrases. The patient may walk repetitively in small circles (volvular epilepsy), run (epilepsia procursiva), or simply wander aimlessly, either as an ictal or postictal phenomenon (poriomania). These forms of seizure, according to some epileptologists, are actually more common with frontal lobe than with temporal lobe foci of origin. Dystonic stiffness of the arm and leg contralateral to the seizure focus is found to be an accompaniment of temporal lobe seizures (more often this is from the supplementary motor of the frontal than the temporal lobes).
In a small number of patients with temporal lobe seizures (7 of 123 patients studied by Ebner et al), some degree of responsiveness (to simple questions and motor commands) is preserved in the presence of prominent automatisms such as lip-smacking and swallowing. Interestingly, the seizures originate in the right temporal lobe. That consciousness should be altered with temporal lobe epilepsy is not at all self-evident. Several mechanisms have been studied, particularly by Blumenfeld’s group, and converge on the effects of temporal lobe discharge on deep structures such as the medial thalamus and the septal nuclei. Amnesia is an important component of the alteration in the state of consciousness in temporal lobe epilepsy but does not explain the entire syndrome.
The patient, in a confused and irritable state, may resist or strike out at the examiner. These types of behaviors, which occur in a limited number of patients with temporal lobe or frontal seizures, usually take the form of nondirected oppositional resistance to restraint. These behaviors manifest during a period of automatic behavior (so called because the patient presumably acts like an automaton) or, more often, in the postictal period. Unprovoked assault or outbursts of intense rage or blind fury are very unusual; Currie and associates found such outbursts in only 16 of 666 patients (2.4 percent) with temporal lobe epilepsy. Penfield once commented that he had never observed a rage state as a result of temporal lobe stimulation. It is exceedingly unlikely that an organized violent act requiring several sequential steps in its performance, such as obtaining a weapon and using it in a directed manner, could represent a temporal lobe seizure.