Successful management of postictal violence with pindolol in temporal lobe epilepsy

We report a case of a 52-year-old man with drug-resistant temporal lobe epilepsy, with post-ictal violent aggressive behaviors. Postictal violent outbursts would occur 3-4 times per year following clusters of seizures or generalized tonic-clonic convulsions. The violent outbursts were traumatizing for his family, and lead to multiple emergency department presentations as well as conflicts with police over the course of nine years. After initiation of pindolol the patient has had no episodes of violent behavior in two years despite experiencing the same frequency and severity of seizures as before pindolol. The abrupt cessation of postictal violent outbursts after introduction of pindolol in this case provides a novel management option for the treatment of postictal violence in patients with drug-resistant epilepsy and supports the importance of the beta adrenergic and potentially serotonergic systems in postictal violent behavior.