Wax ecstatic

I would never have predicted it, but my neuro rotation was the most draining since the surgery block. The reading was intense, we got slammed with consults, and the patients were heartbreaking. So there's a backlog -- I'm still catching up with some of the fascinating tidbits from Neuro, before I can start blogging about the nonstop conga party that is our Emergency Department.

Seizures come in many varieties, such as the "shaky" tonic / clonic kind, the blank stare of the absence seizure, or the vivid sensations in some complex partial seizures. Any of these can be terribly debilitating, but the meds to control them bring their own side effects. So it wasn't surprising when I read about noncompliance -- patients who refused the meds.

What did surprise me was that some patients liked their seizures.

One such series is described by Asheim and Brodtkorb in this article (emphases mine):

Reports focusing on auras of ecstasy or pleasure have been limited largely to single case descriptions. We examined 11 consecutive patients with such ictal symptoms. Eight had sensory hallucinations, four had erotic sensations, five described "a religious/spiritual experience," and several had symptoms that were felt to have no counterpart in human experience. Ictal EEG recordings were performed in four patients; two had seizure onset in the right temporal lobe and two in the left. In seven the onset could not be definitely localized. The diagnosis of epilepsy was often delayed. Eight patients wished to experience seizures; self-induction was possible in five and four showed treatment noncompliance. In patients with insufficient drug intake, in whom good compliance should be expected, it is relevant to consider seizures with pleasant symptomatology. According to the literature, experiential and ecstatic seizures seem to have had a substantial impact on our cultural and religious history.

They go on to elaborate in the paper (academic subscription required):

Although fear by far is the most common affective symptom [3 and 4], several patients experiencing varying degrees of pleasure during partial seizures have been described. Of 100 patients with emotional symptoms as part of a seizure, only 7 described pleasure [3]. However, in another series of 52 such patients as many as 12 reported pleasurable emotions [4].

The symptomatology of "ecstatic seizures" is defined as ictal sensations of intense pleasure, joy, and contentment [5]. Cognitive and spiritual experiences may occur as components [5 and 6]. Patients with these phenomena are rare and may remain undiagnosed for years [7 and 8]. There is little doubt that the Russian writer Fyodor Dostoevsky experienced emotions of ecstatic or pleasant quality during his epileptic seizures and "Dostoevsky epilepsy" is being used as a synonym to epilepsy with such seizures [3, 9 and 10].

What they're reporting isn't that common, but some of the patient's descriptions are worth a look:

Patient 1 -- The first seizure occurred during a concert when he was a teenager. He remembers perceiving short moments of an indefinable feeling. Such episodes recurred and a few months later evolved into a GTC. He characterizes these sensations as "a trance of pleasure." "It is like an emotional wave striking me again and again. I feel compelled to obey a sort of phenomenon. These sensations are outside the spectrum of what I ever have experienced outside a seizure." He also describes cold shivering, increased muscle tension, and a delicious taste, and he swallows repeatedly. He enjoys the sensations and is absorbed in them in a way that he can barely hear when spoken to. When in a particular, relaxed mood, he can sometimes induce seizures by "opening up mentally" and contracting muscles. He denies any religious aspects of the symptoms. "It’s the phenomenon, the feeling, the fit taking control." It lasts a few minutes and afterward he is tired with difficulties expressing himself for about 1 hour.

Patient 2 -- Seizure onset occurred at the age of 7. He felt a twitch in the right side of his face like a sort of a grin and "a profound relaxation, a plus in daily life." In the beginning, the attacks often occurred when passing a particular place on his way to school. He could trigger them by concentrating on recalling former fits. Later the seizures lost some of their pleasant character. At present, he feels that objects in focus move closer and become enlarged and that the surroundings feel strange and unfamiliar as if he is in another world. When undisturbed, he can still enjoy them. Sometimes a strong déjà vu sensation accompanied by nausea dominates, a sensation that usually heralds a GTC [general tonic-clonic].

While the concert-goer sounds like this guy I saw at Pink Floyd (Foxboro '94), he's got EEG findings to back him up.

And one wonders if we don't do something similar when we're sleep deprived. It's different, of course, from a real disease state, but in the same vein of what these patients describe (and it's well known that fatigue lowers the seizure threshold...)

There was one point during Neuro when I was more sleep-deprived than my usual. I pulled two back-to-back all-nighters (writing up the case report on this patient). During a MeFi study break, I discovered this cover Pulp's of Common People by William Shatner and Joe Jackson (with help from Ben Folds). I've been expecting great things from this album, and the song is better than I could have ever hoped. But it probably shouldn't have caused a quasi-religious experience at 4 AM. Right?

These little extraordinary moments are usually worth the sleepy haze of the next day. I've always viewed it, I guess, as the upside to the fear and loathing of procrastination. And if always getting a good night's sleep is going to take these moments away, well, call me noncompliant.

Cross-posted to LingualNerve.com