Dyscontrol syndrome: long-term follow-up

This is a 38- to 57-month follow-up of 50 patients referred for drug-activated electroencephalograms (EEG) because of the suspicion that a limbic complex partial seizure was a crucial mechanism behind their episodic behavior. Hence, an anticonvulsant regimen might be an effective therapeutic option. The primary referral diagnoses were intermittent explosive disorder (N = 33) panic disorder (N = 6), or formes frustes of epilepsy (N = 11). None of the patients had a significant history of typical seizures and previous routine EEGs had all been normal. Twenty nine patients also had a second axis I and three a second axis II diagnosis. On the basis of EEG findings, as well as a symptom checklist of dyscontrol behavior and a history of episodic disorders, I recommended an anticonvulsant regimen in 39 patients; this was initiated by the referring psychiatrist in 25. Of the 11 patients for whom no anticonvulsant was recommended, three were nevertheless placed on such a regimen. At the end of the follow-up period, 12 patients were still on this regimen, eight were on other regimens that probably raised seizural thresholds, and 10 were treated with antidepressants, antimanic, antipsychotic, or anti-anxiety medications. Twenty were not receiving any medication. An analysis of the diagnostic procedure and the response to the various regimens, including psychotherapy, did not demonstrate any reliable data that would aid the clinician in selecting the appropriate regimen. However, of the 20 patients on regimens that raised seizural threshold, 10 reported marked and six reported moderate improvement.