Vol. 4, No. 3, 1998 Page 2


Randy Borum and Kenneth Appelbaum say that "the assessment of aggressive behavior by persons with epilepsy can present a complex challenge for forensic mental health clinicians." To prove their point, they cite an unusual case in which they were involved.

The defendant in the case was charged with indecent assault and battery, and assault with intent to rape. The facts seemed clear: the victim stated that she was bathing one night when she heard the defendant-who had been drinking earlier-banging on her door, yelling, "open it, open it." When she quickly dressed and opened the door, the defendant pushed her into the bathroom, locked the door, and began struggling with her. She managed to escape.

"On the face of it," Borum and Appelbaum say, "the charges... connote a type of planned and directed aggression, perhaps associated with intoxication, that appears inconsistent with epilepsy-related violent behavior." Yet the man was found not guilty by reason of insanity, based on a forensic evaluation and evidence presented at the trial.

Why? The defendant had suffered from epilepsy since childhood. Although his waking seizures were well controlled, he continued to experience nighttime seizures followed by sleepwalking and confusion. During these episodes, he frequently attempted to urinate, sometimes in inappropriate places. A girlfriend, asked to keep a record of these events, recorded 15 episodes in a ten-week period.

Borum and Appelbaum note that in at least one previous sleepwalking episode, the defendant had grabbed a male roommate. "As is characteristic of [post-seizure] states," they say, "when he was confronted, restrained, or interfered with, he tended to make an aggressive response, during which he might grab someone or struggle."

The man's alcohol consumption on the night of the alleged rape may have lowered his seizure threshold, the researchers note. They also point out that the encounter occurred in the bathroom-consistent with the defendant's urge to urinate following seizures-and that he made no attempt to be quiet during the episode. Taken together, Borum and Appelbaum say, the circumstances pointed to a seizure-triggered episode of confusion, rather than a premeditated rape attempt. The jury agreed.

"This case," Borum and Appelbaum say, "clearly points to the necessity and usefulness of reviewing carefully a patient's behavior and history in cases of epilepsy-related aggression."


"Epilepsy, aggression, and criminal responsibility," Randy Borum and Kenneth L. Appelbaum, Psychiatric Services, Vol. 47, No. 7, July 1996, pp. 762-763. Address: Randy Borum, Duke University Medical Center, Box 3071, Durham, NC 27710.

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