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Table of Contents    
LETTER TO EDITOR
Year : 2016  |  Volume : 64  |  Issue : 2  |  Page : 335-336

Commentary: Self-mutilation in epilepsy: An unpleasantly, rare phenomenon


Neurology Unit, Department of Internal Medicine, University of Benin, Benin City, Nigeria

Date of Web Publication3-Mar-2016

Correspondence Address:
Ogunrin Olubunmi Akindele
Neurology Unit, Department of Internal Medicine, University of Benin, Benin City
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.177590

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How to cite this article:
Akindele OO. Commentary: Self-mutilation in epilepsy: An unpleasantly, rare phenomenon. Neurol India 2016;64:335-6

How to cite this URL:
Akindele OO. Commentary: Self-mutilation in epilepsy: An unpleasantly, rare phenomenon. Neurol India [serial online] 2016 [cited 2019 Dec 16];64:335-6. Available from: http://www.neurologyindia.com/text.asp?2016/64/2/335/177590


Sir,

Self-mutilation has been defined as the direct and deliberate self-destruction of a part of a person's own body without the intention of suicide.[1] Major self-mutilation is rare and usually occurs in association with serious mental illness and often results in permanent loss of an organ or its function,[2] with the main forms being ocular, genital and limb mutilation.[3] Although patients with epilepsy (PWE), especially those with generalized seizures associated with loss of consciousness, often suffer from physical harm or injuries, these injuries are not self-inflicted as they occur accidentally during the ictus. Epileptogenic foci situated in the frontal and/or temporal brain regions have been linked to self-mutilation.[4] It is rare to encounter self-mutilation in epilepsy. This makes the case report by Sharma et al., (2015) in this issue of Neurology India an interesting one.[5]

The most common accidental physical injury seen in PWE is soft tissue injury especially tongue bites.[6] In a retrospective study of 264 PWEs with a total of 28,491 seizures, 1371 physical injuries were reported with severe injuries occurring during generalized tonic-clonic seizures. Burn and head injuries were thrice (odds ratio 3.28) and twice (odds ratio 2.73) more likely to occur in PWEs, respectively, than in a non-epileptic population.[6] This study did not report any case of self-mutilation. Virtually all publications on self-inflicted injuries in patients with epilepsy, with the exception of a few meta-analyses, are case reports. Most of these injuries occurred during the ictus. For example, a case of severe oropharyngeal trauma was reported where the trauma was caused by a toothbrush in a 35 year-old PWE who suffered from a seizure while brushing his teeth. The injury went unnoticed for 11 months. Such injuries may also occur in toddlers who fall with a toothbrush in their mouth.[7] Similarly, Shakya et al.,[4] reported the case of a 19-year old boy who episodically tried to harm himself by severely biting only his left ring finger during his seizure attack. In addition, he was found to be harbouring death wishes and suicidal ideation.

This rare case of post-ictal psychosis associated with self-amputation of limb [5] draws attention to severe injuries that may occur in patients with epilepsy having a temporal origin of their epilepsy. It is, however, important to exclude patients with Kluver-Bucy syndrome, a condition that was first seen in a patient with bilateral temporal damage due to herpes simplex meningoencepahilitis, and is characterized by hyperorality, indiscriminate hypersexuality, hypermetamorphosis, placidity, seizures and psychic blindness.[8] Some of these patients may self-inflict.

There is a need to evaluate patients with epilepsy who self-mutilate, for depression and suicidal tendency. It is an understatement that caring for patients with epilepsy demands a comprehensive cares approach that goes beyond drug therapy. It involves a multi-disciplinary approach incorporating the expertise of a neurologist, neurosurgeon, clinical psychologist, psychiatrist and social worker among others. In addition, closer observation of the patients during their ictus is crucial to preventing these unpleasant events of self-mutilation.

 
  References Top

1.
Favazza A. Bodies Under Siege. Baltimore: John Hopkins University Press; 1987.  Back to cited text no. 1
    
2.
Favazza A, Rosenthal R. Diagnostic issues in self-mutilation. Hosp and Community Psychiatry 1993;44:134-40.  Back to cited text no. 2
    
3.
Large M, Babidge N, Andrews D, Storey P, Nielssen O. Major self-mutilation in the first episode of psychosis. Schizophrenia Bulletin 2009;35:1012-21.  Back to cited text no. 3
    
4.
Shakya DR, Shyangwa PM, Pandey AK, Subedi S, Yadav S. Self injurious behaviour in temporal lobe epilepsy. JNMA J Nepal Med Assoc 2010;49:239-42.  Back to cited text no. 4
    
5.
Sharma SR, Nongpiur A, Hussain M, Habung H. Postictal psychosis with self-amputation of foot in an epileptic patient: A case report. Neurol India 2015;64:327-8.  Back to cited text no. 5
    
6.
Asadi-Pooya AA, Nikseresht A, Yaghoubi E, Nei M. Physical injuries in patients with epilepsy and their associated risk factors. Seizure 2012;21:165-8.  Back to cited text no. 6
    
7.
Kumar S, Gupta R, Arora R, Saxena S. Severe oropharyngeal trauma caused by toothbrush – Case report and review of 13 cases. British Dental Journal 2008;205:443-7.  Back to cited text no. 7
    
8.
Jha S, Patel R. Kluver-Bucy syndrome – An experience with six cases. Neurol India 2004;52:369-71.  Back to cited text no. 8
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