From volitional action to automatized homicide: changing levels of self and consciousness during partial limbic seizures

Refined definitions are proposed for subtle, transient changes primarily of the “sense of self,” as expressed in observable action behavior due to neuro-pathological disturbances, especially during partial seizures' interfering with volition. Two such subtypes are exemplified by temporal lobe epilepsy (TLE), typically with clouding of consciousness (with amnesia for the acts), and by the proposed “Limbic Psychotic Trigger Reaction” (LPTR). During LPTR, consciousness is preserved to the extent that such seizure-stricken patients remember their acts, which are associated with a fleeting de novo psychosis and autonomic arousal. The acts are nonvolitional, unplanned, nonintended, motiveless, purposeless, and out-of-character, ranging from socially bizarrely inappropriate behavior to homicide. Basic “paleo” levels of the sense of self and of consciousness are preserved: Such patients “know” the nature, i.e., the kind of action, while they transiently lose their previously characteristic ability to fully appreciate the “quality” of their acts, their consequences, and implications.