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Erotomania (Nymphomania) as an expression of cortical epileptiform discharge
Abstract
Relatively little is known in regard to the representation of the sacral segments of the cord in the cerebral cortex of man. Penfield and Boldrey¹ (1937) recorded sensation in the opposite side of the penis following cortical stimulation but obtained no motor responses. They pointed out that the rarity of responses in the lower sacral and genital regions may be due to the comparatively small number of stimulations which the neurosurgeon is able to perform within the central fissure, or possibly to a false sense of modesty on the part of the patient. Scarff² (1940) observed contraction of the anal sphincter in 1 patient after electrical stimulation of the medial surface of the cerebral hemisphere.
In contrast to the paucity of observations in man, the representation of the sacral segments has been worked out with considerable precision in the cortex of the monkey (Woolsey, Marshall and Bard,³
... Along with Penfield's work, one of the earliest case studies to consider the relative locations of various elements of female genitalia was that of a woman with epilepsy (Erickson 1945). This patient was diagnosed with ''erotomania'' because she experienced vaginal sensations similar to those felt during intercourse in tandem with her seizures. ...
... Although he offers no sequential order for the cortical representation of these sensory and motor areas, he does suggest that the suspected causal tumor in the patient's right parietal parasaggital region (deep within the cerebral hemisphere) put pressure on a proposed genital region within the medial SS. In support of this hypothesis, Erickson notes a relief from the ''nymphomanic'' symptoms upon removal of the tumor, as reported during a 1-year follow-up (Erickson 1945). This report came before Penfield reported on E.C. explicitly but supports his mapping of the relationship of the foot to the female genitalia. ...
... Brain activity during orgasm showed peak rCBF in S1 with significant clusters of activity in dorsal M1 cortex, the paracentral lobule, and the dorsal aspect of the central sulcus (Georgiadis et al. 2006). From this, we can infer that the clitoral localizations suggested by this study are not consistent with Penfield's localization of the homologous structure, the penis, on the medial wall (or paracentral lobule) of the postcentral gyrus, nor with traditionally postulated localizations (Gru¨nbaum and Sherrington 1901;Erickson 1945), and in nonhuman primate studies (Woolsey et al. 1942). However, they are consistent with results from Woolsey's later studies on nonhuman primates (Woolsey et al. 1979) and more recent studies that utilize functional magnetic resonance imaging (fMRI) to reexamine the somatotopic representation of the human male penis, which has also been localized to the dorsal surface of the postcentral gyrus, lateral to the representation of the toe and not, as mapped by Penfield, on the paracentral lobule (Kell et al. 2005). ...
The representation of the body in the brain, the homunculus, was posited by Wilder Penfield based on his studies of patients with intractable epilepsy. While he mapped both male and female patients, Penfield reports little about the females. The now iconic illustration of the map is clearly male with testicles, penis, and no breasts. In order to bring attention to this omission and to stimulate studies of female somatosensory cortex (SS), we discuss what is known about the map of the female body in the brain, including Penfield's findings in his female patients and subsequent work by others exploring the human female SS. We reveal that there is much we do not know about how the entire female body is represented in the brain or how it might change with different reproductive life stages, hormones, and experiences. Understanding what is and is not currently known about the female SS is a first step toward fully understanding neurological and physiological sex differences, as well as producing better-informed treatments for pain conditions related to mastectomy, hysterectomy, vulvodynia, and fibromyalgia. We suggest that the time is ripe for a full mapping of the female brain with the production of a hermunculus.
... Erickson described the first clearly-defined case of SD due to a cortical lesion. The patient experienced spontaneous sexual feelings in the vagina, caused by a tumor in the right paracentral lobule, which was suspected to irritate the area of cortical representation of the genitalia [43]. Then, while some authors reported an association between hypersexuality, epilepsy, and tumors in the temporal lobe (particularly the amygdala) [44], others observed an association between sexual impotence and tumor invasion of the limbic system (anterior hippocampus and cingulum) [42]. ...
Simple Summary
Patients suffering from diffuse Low-Grade Glioma (LGG) are usually young adults and present long life expectancy thanks to multimodal therapeutic management. In this context, the preservation of quality of life (QoL) is essential, and sexual health is part of it. We reviewed here the current knowledge about sexual dysfunction in LGG patients. We highlighted how this issue has been largely neglected, despite an incidence from 44 to 62% in the rare series of the literature. Thus, there is a need to assess more systematically the occurrence of SD in clinical routine in order to adapt cancer treatments accordingly, to manage actively these troubles, and finally to improve patients’ QoL in the long run.
Abstract
Diffuse low-grade gliomas (LGG) commonly affect young adults and display a slow evolution, with a life expectancy that can surpass 15 years, thanks to multimodal therapeutic management. Therefore, preservation of quality of life (QoL), including sexual health, is mandatory. We systematically searched available medical databases of Pubmed, Cochrane, and Scopus for studies that reported data on sexual activity or dysfunction (SD) in LGG patients. We analyzed results to determine incidence of SD and its association with QoL in this population. Three studies focused on SD incidence in patients presenting specifically LGG, or brain tumors including LGG. They comprised 124 brain tumor patients, including 62 LGG, with SD incidence ranging from 44 to 63%. SD was reported by more than 50% of interrogated women in the three studies. Regarding QoL, two out of the three studies found significant associations between SD and alterations of QoL parameters, particularly in the field of social and functional wellbeing. Finally, we discussed those results regarding methods of evaluation, inherent biases, and therapeutic implications regarding antiseizure medications and also planning of surgery, chemo-, and radiotherapy. Our review showed that SD is highly prevalent but still poorly studied in LGG patients. As those patients are usually young and enjoy an active life, there is a need to assess more systematically the occurrence of SD in clinical routine, in order to adapt cancer treatments accordingly, to manage actively these troubles, and finally to improve patients’ QoL in the long run.
... Later, cortical representations of the rectum were found by Scarff (1940) who described contractions in the rectal sphincter (measured by a physician inserting his finger in the patient's rectum) which were caused by cortical stimulations near the corpus callosum in the medial wall. Another case of genital sensation was reported by Erickson (1945). Although cortical stimulation did not invoke genital sensation, the female epileptic patient suffered from orgasmic seizures and hypersexual episodes accompanied by genital sensations which went beyond just sensory perception of the genitalia and actually lead to erotic feelings. ...
Many reviews on sexual arousal in humans focus on different brain imaging methods and behavioral observations. Although neurotransmission in the brain is mainly performed through electrochemical signals, there are no systematic reviews of the electrophysiological correlates of sexual arousal. We performed a systematic search on this subject and reviewed 255 studies including various electrophysiological methods. Our results show how neuroelectric signals have been used to investigate genital somatotopy as well as basic genital physiology during sexual arousal and how cortical electric signals have been recorded during orgasm. Moreover, experiments on the interactions of cognition and sexual arousal in healthy subjects and in individuals with abnormal sexual preferences were analyzed as well as case studies on sexual disturbances associated with diseases of the nervous system. In addition, 25 studies focusing on brain potentials during the interaction of cognition and sexual arousal were eligible for meta-analysis. The results showed significant effect sizes for specific brain potentials during sexual stimulation (P3: Cohen's d = 1.82, N = 300, LPP: Cohen's d = 2.30, N = 510) with high heterogeneity between the combined studies. Taken together, our review shows how neuroelectric methods can consistently differentiate sexual arousal from other emotional states.
... Genital auras are characterized by unpleasant, sometimes painful, frightening or emotionally neutral somatosensory sensations in the genitals and can be accompanied by ictal orgasm. Genital auras are generated by epileptic discharges in the parasagittal postcentral gyrus where the cortical representation of genital sensation resides [139][140][141][142]. ...
Purpose
To review the epidemiology and pathophysiology of autonomic symptoms and signs during epileptic seizures.
Methods
We performed a systematic literature search on the following autonomic symptoms and signs during epileptic seizures: cardiovascular changes, respiratory manifestations, gastrointestinal symptoms, cutaneous manifestations, sexual and genital manifestations, and urinary symptoms.
Results
Autonomic symptoms and signs can represent the predominant symptom at the onset of a focal seizure, which would then lead to the seizure being classified as a focal onset autonomic seizure. Conversely, clinically relevant autonomic symptoms and signs frequently accompany seizures of focal, generalized, and/or unknown onset, but the seizure is regardless classified according to other, more relevant features. Autonomic symptoms and signs do not represent mere reactions to motor activity or other behavioral seizure manifestations, but rather they are generated by epileptic discharges affecting the central autonomic network. We have reviewed the localizing and lateralizing information currently available on the seizure onset zone and on seizure propagation pathways as provided by systematic analysis of specific autonomic seizure symptoms and signs. We present data on how autonomic seizure symptoms and signs are useful for gaining a better understanding of the anatomical and functional organization of the central autonomic network. Finally, we discuss the differential diagnosis of focal autonomic seizures with autonomic symptoms and signs representing the sole seizure manifestation versus various non-epileptic conditions.
Conclusions
Autonomic seizure symptoms and signs are relevant in clinical epileptology and open a unique window on the functional organization and pathophysiology of the central autonomic network.
... 1,3,4 As described in the literature, parasomnias often involve the release of instinctual behaviors during sleep, and this is particularly true with the NREM sleep parasomnias, as locomotion, aggression, eating and sex can each be inappropriately activated from sleep. 2 With sexsomnia as a parasomnia, a full range of sexuality can be expressed (sexual verbalizations/vocalizations, masturbation, fondling the bed partner, initiating sexual intercourse), but in a non-stereotypical manner. 1,3,[9][10][11]24,[41][42][43][44] In regards to sexsomnia, the vast majority of reported cases do not emerge as an isolated NREM sleep parasomnia, but often emerge in patients with various other longstanding NREM parasomnias (e.g. sleepwalking, sleep terrors) for whom sexsomnia is just the latest parasomnia to affect them 1,3 .Furthermore, three cases of sexsomnia have been reported with the Parasomnia Overlap Disorder (NREM parasomnia and REM sleep behavior disorder affecting the same patient). ...
Study Objectives
Complex sexual behavior during sleep (CSBS) is a well described clinical entity in NREM sleep parasomnias (i.e. sexsomnia). We report a retrospective case series of CSBS as clinical manifestation of epileptic seizures and compare them with the semiology of sexsomnia.
Methods
Video-EEG-monitoring data of patients with epileptic and non-epileptic paroxysmal events from one tertiary epilepsy center between 2013–2016 were retrospectively reviewed. Clinical features and presurgical, electroclinical, and follow-up data are presented and then discussed in the context of other published cases.
Results
From 4629 patients, six patients had CSBS. EEG, SPECT, MRI and histopathology confirmed an epileptic origin in 4 female patients, with temporal or frontal seizures. Two male patients had sexsomnia. None of the epilepsy patients had parasomnias. Clinical criteria to differentiate epileptic from parasomnic CSBS were: Events also occurred out of wakefulness; current presence of additional non-sexual manifestations of epilepsy; sexual behavior only as part of a broad spectrum of emotional and motor automatisms; stereotyped behavior pattern without modulability by bystanders; unarousability during the event; no completion of sexual intercourse. The accuracy of the clinical diagnosis was improved by the development of an algorithm comparing patients` fulfillment of the criteria of epilepsy vs. parasomnia.
Conclusions
In our cohort CSBS was a rare ictal phenomenon in temporal or frontal seizures. Symptomatological similiarities with sexsomnia might be explained by the same phylogenetically primitive “central pattern generator” manifesting in ictal CSBS by activation and in sexsomnia by disinhibition. Ictal CSBS should be considered in the differential diagnosis of sexsomnia.
Sexual hallucinations are little known, yet often extremely burdening, phenomena. In this systematic review, we summarize what is known about their phenomenology, prevalence, etiopathology, ensuing distress, and treatment options. Sexual hallucinations can be experienced as genital or orgasmic sensations, although other sensory modalities can also be involved. With the notable exception of orgasmic auras in the context of epilepsy, sexual hallucinations tend to be distressing and embarrassing in nature. Our analysis of 79 studies (together describing 390 patients) indicates that sexual hallucinations are more frequent in women than in men, with a sex ratio of 1.4:1, and that they are most prevalent in schizophrenia spectrum disorders, with rates ranging from 1.4% in recently admitted patients to 44% in chronically hospitalized patients. Other underlying conditions include epilepsy, the incubus phenomenon (possibly the most prevalent cause in the general population, associated with sleep paralysis), narcolepsy, and sedative use. As regards the sedative context, we found more medicolegal than purely medical cases, which sadly underlines that not all sexually explicit sensations experienced in anesthesia practice are indeed hallucinations. In the absence of evidence-based treatment protocols for sexual hallucinations, practice-based guidelines tend to focus on the underlying condition. Further research is needed, especially in the fields of substance abuse, posttraumatic stress disorder, and borderline personality disorder, where only anecdotal information on sexual hallucinations is available. Moreover, awareness of sexual hallucinations among health professionals needs to be improved in order to facilitate counseling, diagnosis, and treatment.
Purpose: The most a set of illnesses that impact both men, as well as women; include sexual aversion disorder (S.A.D) and hypoactive sexual desire disorder (H.S.D.D). Nevertheless being common, those same two illnesses are frequently ignored by medical professionals as well as clients owing to their private and more intimate character. In order to accurately handle our clients' sexual difficulties and execute effective therapy, we as clinicians must go over our own discomfort and in this paper, common sexual disorders will be addressed with the touch of their neuropsychological etiology. Objective: The major objective of this article is to describe numerous sexual desire issues and how they relate to the brain. Erectile dysfunction and a few other sexually transmitted diseases are at least known to people (STDs). In addition to having a limited understanding of sexual problems brought on by viruses and other microbes, society also has little to no awareness of those brought on by brain injury or the dysfunction of certain brain areas. Therefore, one of the primary goals of this essay is to clarify popular and widespread diseases of sexual desire and their relationship to illnesses of the brain or other pathologies. Design/Methodology/Approach: The scientific and secondary clinical data for this work were gathered from reliable sources like Google Scholar, Academia, Researchgate, and others. The results of national and international studies on the topic issue have been assembled methodically and scientifically. In order to make this document more scientifically sound, reliable, and accurate, each scientific journal research result underwent a thorough, methodical, and scientific assessment. To increase this paper's uniqueness and reliability, we gathered the thoughts of a variety of experienced experts. Findings/Result: According to emerging knowledge, the temporal areas play a critical role in the regulation of erotic functioning. The amygdala is assumed to play a major role in managing human sexual impulses. This approach emphasizes the need for more study into the neural mechanisms behind this fundamental and permanent aspect of human nature. It is hoped that such an examination would lead to more studies, particularly through key brain regions that have already been identified by researchers. Another viewpoint is that sexual arousal disorders are poorly understood and treated, which leads to significant comorbidity as well as mortality in romantic relationships. Originality and Value: An innovative attempt has been made to provide information on a number of common sexual desire problems and how they may be treated with psychotherapy and psychopharmacology. Information is gathered from researchers and subject-matter specialists to make the paper vibrant and precise. The report was written so that everyone who read it, regardless of academic background, could grasp this clinical problem. A fresh attempt has been undertaken to spread a clinical understanding of sexual desire problems and their relationship to the brain in a more straightforward manner. This paper was created in the hopes that readers will be able to comprehend problems of sexual desire by bearing in mind how they relate to the brain. Paper Type: Clinical analysis paper
The answer to the question of what determines gender identity in hermaphrodites is still not definitively answered in spite of much research that was described in the previous chapter. All the findings show the enormous influence played by sex assignment at birth and rearing, and some workers, like Ellis (1945) and Money and his co-workers (Money, Hampson, & Hampson, 1957) even conclude from their studies of hermaphrodites that sex assignment at birth and rearing play the overriding roles in determining not only gender identity but also eroticism.
A group of 67 psychomotor epileptics undergoing detailed psychopathological examination, were also questioned on the sexual aspects of their condition. The results are in agreement with the findings first established by Griesinger (1868/69) and confirmed later by Gastaut and Collomb (1954) and by Blumer and Walker (1967).
Between attacks there is almost invariably a global hyposexuality with little or no interest in anything connected with sex. When an attack is coming on, there may be a transient hypersexuality. Abnormal sexual behaviour was not any more common than in a group of 318 epileptics of all types who were examined for criminal tendencies.
There can be paroxysms of abnormal sexual behaviour as a symptom of nonconvulsing epilepsy. This has been seen only in isolated cases.
The sexual disturbances are all much improved if medical or surgical treatment is successful in reducing the frequency of attacks.
Sexual behaviors differ from society to society and from individual to individual. Beliefs about which sexual practices are good, moral, and natural and which are wrong, immoral, and unnatural are mutable. Certain types of sexual behaviors are thought to be exhibited by only a small portion of the people of our society. Because of the presumed rarity and because of the difference between these practices and accepted sexual norms, these sexual behaviors are of interest to those who study human behavior. In this chapter we will attempt to review objectively the information available on the syndromes of necrophilia, vampirism, zoophilia, autoerotic asphyxia, coprophilia, rare types of incest, and hypersexuality. The intention is to provide the reader with a clear and objective view of the range of human sexual behavior.
Many members of Western civilization experience emotion as a potentially overwhelming force that warrants and yet resists control—as something irrational that can happen to you (“you make me so angry”). Perhaps in part, this schism between the rational and the emotional is attributable to the raw energy of emotion having its source in the nuclei of the ancient limbic lobe—what some have referred to as the reptilian brain, a series of nuclei that first made their phylogenetic appearance long before man walked upon this earth. Although over the course of evolution a new brain (neocortex) has developed, we remain creatures of emotion. We have not completely emerged from the phylogenetic swamps of our original psychic existence. The old limbic brain has not been replaced.
Over the course of evolution, each half of the brain has developed its own unique strategy for perceiving, processing, and expressing information as well as specialized neuroanatomical interconnections that assist in mediating these functions. Indeed, the human brain is organized such that two potentially independent mental systems coexist, literally side by side. (cf. Gazzaniga & LeDoux, 1978; Joseph, 1982, 1988a,b; Levy, 1983; Sperry, 1966, 1982).
Disorders of sexual function in the human result from a remarkable variety of structural lesions involving the nervous system. Sexual dysfunction is widely recognized as a reflection of disorders of the peripheral nervous system and of the spinal cord; however, it is less widely appreciated that lesions of the cerebral hemispheres may also produce changes in this respect, at times so startling, dramatic, or bizarre as to be regarded, albeit inappropriately, as psychogenic in origin. It is tempting to suggest a simple dichotomy in this respect: lesions in the peripheral nervous system might be expected to induce disorders of potency, involving erection, ejaculation, or both, whereas lesions of the central nervous system, and particularly of the cerebral hemispheres, might be anticipated to result in disorders of libido, i.e., of sexual energy and desire. This division may be valid to a point but, as will be seen, does not really hold up to critical scrutiny, and in general, one cannot determine with certainty, on the basis of the type of sexual disorder alone, the site of neural involvement in any given patient.
Neuropsychiatric syndromes may be defined as the clusters of behaviour, mood, emotional and cognitive disturbance which occur as the result of brain disease. The organic mental disorders, as defined in the DSM-III-R, (American Psychiatric Association, 1987) can be used to classify this group of syndromes. Neuropsychiatry has been described as “the specialty dealing with both organic and functional diseases of the nervous system” (Stedman’s Medical Dictionary, 1982). However, in trying to conceptualize neuropsychiatric disease, the artificial division of disorders into “organic” and “functional” seems redundant. A more integrated view, linking physiological and mental processes, is required. Fortunately, there has been a dramatic growth in interest and research in this field with major contributions from geriatric and biological psychiatry, behavioural neurology and neuropsychology.
It is over a century since Fritsch and Hitzig, Ferrier, and Jackson laid down the experimental and clinical basis for functional localization in persons both with and without seizure disorders, and it is over 50 years since Foerster, Penfield, and their collaborators began applying these insights systematically to the surgical treatment of intractable seizures.
This paper analyzes the sexuality in the epileptic patient, in special, the complex partial seizures in the temporal lobe. The sexuality is a very important function in the person, and the changes that may accompany temporal lobe dysfunction tend to be in the direction of hyposexuality, although the opposite may be true. Due to all this, there is a need to carry out training schemes that can be implemented at the family of the epileptic patient. Sexual alterations due to temporal lobe's partial complex epilepsy leads to thoughts about the epileptic focus and its influences on the limbic structures being the most likely cause of sexual distortion, leaving causes as pharmacological iatrogenic and fear to crisis activation due to the coitus in the background.
Sexual disorders are much more frequent in epileptic patients than in the general population and are a concern for women and men. As a whole, approximately one to two thirds of patients of both sexes present with one or more symptoms of sexual dysfunction. The most important disorders, by far the most frequent, are inter-ictal, with hyposexuality in the vast majority of cases, which concerns one or several aspects or parts of the sexual drive and response, namely desire, excitement or arousal, and orgasm. These disorders occur predominantly in patients with partial epilepsy, especially temporal lobe epilepsy but are observed also in idiopathic generalized epilepsies. Disturbances causing sexual dysfunctions are certainly multiple, psychological but also physiological, and tightly linked for several of them. Etiology of sexual disorders in epilepsy is not yet well understood, and is almost surely multifactorial. Contributing and/or aetiological factors may be related to the epileptic discharges and seizures, to the epileptogenic lesion, to several psychical, cognitive or social disturbances, to hormonal and neuro-endocrine abnormalities, to side-effects of antiepileptic drugs and to the surgical treatment of the epilepsy. Ictal-related disorders are much more infrequent. They encompass, on one hand seizures with ictal sexual symptoms or signs, and on the other hand very rare seizures which appear facilitated or triggered by sexual activity or orgasm. Due to the high frequency of interictal sexual disorders and their heavily negative influence on the quality of life, to optimize the diagnostic and the treatment of sexual disorders in epileptic patients is certainly a crucial medical objective.
Description of the neural control of the individual pelvic organs can be found in Chapters 1–3. Much of that knowledge is based on recent data acquired by functional brain imaging but prior to the advent of those powerful techniques, what we knew about the role of the cortical and subcortical areas in the control of pelvic organs relied on a small number of carefully observed clinical cases: Patients presenting with specific symptoms of bladder or bowel dysfunction or abnormalities of sexual behavior who had been found to have lesions at particular brain sites. Initially the lesion studies were based on observations made in life correlated with post-mortem or pathological specimens, but with increasingly better means of imaging it was possible to correlate symptoms with smaller, more discrete abnormalities. For various reasons, fewer case histories are now occupying space in journals and the majority of the case histories referred to in this chapter are more than 20 or 30 years old. The “lesion literature” is quite sparse for all three functional systems and is summarized in Tables 11.1–11.3 [1–45]. In this chapter, first the case histories and the “lesion literature” are discussed and the effects of injury or disease at focal sites described, and then the results of diffuse cortical and subcortical diseases, such as cerebrovascular disease, dementias and head injury, are considered.
The neurology of human sexual responses is poorly understood, not only because it is a highly complex process involving much of the nervous system, but also because in comparison to the extent to which research has been carried out in experimental animals, humans have been relatively little studied. Whereas in animals the central and peripheral nervous system control of penile erection and copulatory behavior have been intensively examined, our knowledge about human function and the brain is based mainly on a synthesis of observations of reported abnormalities resulting from disease [1]. Now, however, functional brain imaging data have begun to complement those data. Homology between primates and rodents has been shown for many aspects of sexual responses but there remains much that is unknown about the more complex human processes, especially the neurological determinants of sexual desire. After defining the various phases of the human sexual cycle, this chapter outlines the roles of the subcortical and cortical regions, spinal connections and peripheral innervation involved in those phases, with reference to the experimental animal literature and mention of the dysfunctions that can result from neurological disease at each level. Findings from recent functional imaging experiments are discussed in the context of the role of the cortical regions in human neurological control of sexual function.
The hypothalamo-hypophyseo-gonadal axis has been generally looked upon as the neuroendocrine basis of sexual behavior and many animal studies support this view. Higher neuronal circuits must be involved in sexuality, at least in man, but there has been little curiosity and little knowledge concerning these mechanisms.
IntroductionLove is a complex emotional state which is difficult to define. Considering anthropological studies, this feeling can now be divided into three distinct behaviors: lust, attraction for a specific partner and conjugal or filial attachment.
Permit me to begin by saying how pleased and proud I am to have received the invitation to deliver this year's Maudsley lecture. This is, I think, one of the highest honours that our psychiatric confraternity can confer on any of its members, and is something that the recipient will treasure as an enduring reward.
Loss of sexual desire and impairment of sexual function in patients with symptoms of cervical spinal cord involvement without paralysis were found in 85 patients of both sexes in a series of 2076 consecutive patients seen during a 13-year period. History of trauma was given by 79 patients. Compression of the spinal cord and nerve roots by disc herniation, contusion, and/or edema from hyperextension and flexion injuries in the patients with sexual dysfunction was the most probable cause of damage to the intermediolateral column of cells in the lateral horn. In another study, sections of the spinal cords of 11 patients, who had been subjected to lower cervical cordotomies, showed destruction of the lateral horn of the spinal cord in 3 patients who had experienced sexual dysfunction. Sexual function improved in 77% of patients with surgically treated cervical spinal cord injuries and in 26% of conservatively treated patients.
Recommends a holistic biopsychosocial approach to the counseling and management of neurologically ill and handicapped people, which would include examining aspects of the patient's sexuality. This article describes the sexual problems associated with a variety of neurological disorders. These disorders include hypothalamo-pituitary disorders, stroke, brain lesions, epilepsy, narcolepsy, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, paraplegia and tetraplegia, spinal cord malformations, myelopathies, spinal canal stenosis, sacral nerve rhizopathies and peripheral mononeuropathies, diabetic and nondiabetic polyneuropathies, and headaches suffered during intercourse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The case of a 39-years old left-handed man is reported who exhibited transvestite and fetishist behaviour from the age of 9 on, and 20 years later developed temporal lobe epilepsy which gradually became severe. Investigation revealed a left anterior temporal focus and he was treated by anterior temporal lobectomy. Since then he has remained fit-free for 15 months and has lost his perversion. The neuro-psychiatric relations of the two conditions are discussed and a possible connection between them is traced.
Communication d'un cas concernant un homme de 39 ans, gaudier, dont le comportement manifestait depuis l'âge de 9 ans du goût pour le travestissement et le fétichisme: il se développa chez lui, 20 ans plus tard, une épilepsie temporale dont la gravité augmenta graduellement. L'examen a révelé un focus temporal antérieur gauche et le malade a été traité par lobectomie temporale antérieure. Depuis cette époque, il a passé 15 mois sans avoir d'accès et a perdu sa perversion. Discussion des rapports neuro-psychiatriques des deux conditions; l'auteur cherche la possibilityé d'une relation entre les deux.
samenvatting Erectiestoornissen en vroegtijdige zaadlozing kunnen met medicijnen effectief worden behandeld. Deze medicijnen oefenen hun
werking uit door interactie met processen in het centraal zenuwstelsel of de penis zelf. Hierbij speelt bij de erectie het
pde-5-enzym en bij de zaadlozing het serotonine-metabolisme een essentiële rol. Farmacotherapie van deze bij de man optredende
seksuele disfuncties is een waardevolle vervanging of aanvulling op bestaande psychotherapeutische behandelmethoden.
Drug treatment was shown to be effective in erectile disorder and premature ejaculation. These drugs interfere with processes
in the central nervous system or locally in the penile tissue. Effective agents against erectile dysfunction act by inhibition
of the pde-5 enzyme in penile blood vessels whereas agents against premature ejaculation influence serotonin metabolism in the central
nervous system. The pharmacotherapeutic approach of the aforementioned male sexual disorders is considered to be a valuable
addition or replacement of psychotherapy.
Seventy cases each of temporal lobe epilepsy and grand mal epilepsy were studied for their sexual functioning. The two groups were similar as regards age, sex, duration of illness, frequency of seizures and menstrual and marital history.
A significantly greater number of temporal lobe epileptics were found to be hyposexual. They had a global loss of performance and interest in the sexual sphere and showed no concern over it.
One case in the group of temporal lobe epilepsy, as against none in the other group, was hypersexual. There were no cases of sexual deviations in either of the groups.
The findings of the study are discussed in the light of the relevant literature.
This paper reports and illustrates in figurine style results obtained by electrical stimulation of the cortex in 20 patients and by recording of cortical evoked potentials (EPs) in 13 of these patients, whose surgery required wide exposure of the Rolandic or paracentral regions of the cortex. This study is unique in that cutaneous receptive fields related to specific cortical sites were defined by mechanical stimulation, as is done in animals, in contrast to electrical stimulation of peripheral nerves at fixed sites, as in scalp EP recordings. Observations were made on pre- and postcentral gyri, on the second somatic sensory-motor area, on the supplementary motor area, and on the supplementary sensory area. In two patients with phantom limb pain, the pain was elicited in one on stimulation of the postcentral arm area, and in the other on stimulation of the supplementary sensory leg area. Surgical removal of these areas had the immediate effect of abolishing the phantoms and the pain. Long-term follow-up review was not possible. In one patient with severe Parkinson's disease, stimulating currents subthreshold for the elicitation of movement resulted in disappearance of tremor and rigidity for short periods after stimulation of the precentral gyrus. The possible patterns of organization of the human pre- and postcentral areas are considered and compared with those of the chimpanzee and other primates. In patients in whom data from pre- and postcentral gyri were adequate, it appeared that the precentral face-arm boundary is situated 1 to 2 cm higher than the corresponding postcentral boundary.
Does sexual feeling have a cerebral cortical localization? Although information on this is sparse, the case histories of two patients with epilepsy support the likelihood that sexual feeling has a representation in the sensory cortex of the paracentral lobule.
Hypersexual behavior was induced in adult male cats by repeatedly evoked limbic system seizures. Accentuation of Dopaminergic
activity with drugs was used to facilitate development of the seizure induced hypersexuality. Hypersexuality consisted of
biting knap of neck, mounting, thrusting and coital intromission. The gradual development and eventual disappearance of hypersexuality
was correlated with the progressive prolongation of the seizures in their evolution. There are three stages of seizure evolution
in relation to sexuality. First stage-normal sexuality, intermediate stage-hypersexuality and late stage-hyposexuality. A
theoretical “hypersexual growth and decay curve” was constructed in relation to the evolution of limbic seizure durations
in the intermediate stage. It was suggested that the observed hypersexuality was related to the early discharge activation
of hypothalamic, preoptic and basal ganglia neurohumeral facilitatory mechanisms for sexuality, and the late effects were
related to discharge activation of brain stem serotonergic inhibitory mechanisms. The discussion attempts also to use these
experimental findings to explain clinically observed hyposexuality and hypersexuality. It was suggested that either hypersexuality
or hyposexuality may be associated with psychomotor seizures and that the predominating sexual state at a given moment is
dependent upon the evolutionary stage of the seizure at that moment. Consequently, psychomotor seizures with associated hypersexuality
should not be considered a clinical anachronism. In fact, these observations support the impression that rape may be a manifestation
of a psychomotor seizure.
A case is presented of a 31 yr old man with temporal lobe epilepsy with probably, multiple foci of origin on the right side. His attacks included an 'orgasmic like' sensation which spread across his face from right to left and was followed by muscle twitching which extended into the left neck and arm. The sensations were unpleasant because of their location. Various features of temporal lobe dysfunction are discussed as well as the clinical aspects of the case.
Based on a review of numerous studies conducted on normal, neurosurgical and brain-injured individuals, the right cerebral hemisphere appears to be dominant in the perception and identification of environmental and nonverbal sounds; the analysis of geometric and visual space (e.g., depth perception, visual closure); somesthesis, stereognosis, the maintenance of the body image; the production of dreams during REM sleep; the perception of most aspects of musical stimuli; and the comprehension and expression of prosodic, melodic, visual, facial, and verbal emotion. When the right hemisphere is damaged a variety of cognitive abnormalities may result, including hemi-inattention and neglect, prosopagnosia, constructional apraxia, visual-perceptual disturbances, and agnosia for environmental, musical, and emotional sounds. Similarly, a myriad of affective abnormalities may occur, including indifference, depression, hysteria, gross social-emotional disinhibition, florid manic excitement, childishness, euphoria, impulsivity, and abnormal sexual behavior. Patients may become delusional, engage in the production of bizzare confabulations and experience a host of somatic disturbances such as pain and body-perceptual distortions. Based on studies of normal and "split-brain" functioning, it also appears that the right hemisphere maintains a highly developed social-emotional mental system and can independently perceive, recall and act on certain memories and experiences without the aid or active reflective participation of the left. This leads to situations in which the right and left halves of the brain sometime act in an uncooperative fashion, which gives rise to inter-manual and intra-psychic conflicts.
We studied a 41‐year‐old woman who had nocturnal somatosensory seizures followed by orgasm. The interictal EEG showed discrete left central parietal region paroxysmal activity that markedly increased during sleep. Eight electroclinical seizures were recorded during sleep polygraphic recording. Orgasms occurred coinciding with generalization of paroxysmal activity. No abnormalities were found on serial neurologic examination or computed tomography scan. The attacks were completely controlled with antiepileptic drugs.
RÉSUMÉ
Les auteurs rapportent ľobservation d'une femme âgée de 41 ans qui présentait des crises nocturnes somatosensitives suivies d'un orgasme. ĽEEG intercritique a mis en evidence de discretes anomalies paroxystiques de la rdgion pariétale gauche, tres accentuées par le sommeil. 8 crises electrocliniques ont été enregistries sous polygraphie de sommeil. Les orgasmes coi'ncidaient avec une generalisation des activitis paroxystiques. Les examens neurologiques répétés et la scanographie cérébrale n'ont pas mis en Evidence d'anomalie. Les crises ont disparu sous medication antiepileptique.
RESUMEN
Estudiamos una paciente de 41 anos con crisis somatosenso‐riales nocturnas seguidas de orgasmo. Los trazados EEG interic‐tales revelaron una discreta actividad paroxística en la regidn centro‐parietal izquierda, que incrementaba marcadamente durante el sueno. Se registraron ocho crisis durante el registro po‐ligrafico de sueno. Los orgasmos ocurrian coincidiendo con la generalizacidn de la actividad paroxistica. No se detectaron anomah'as en los examenes neurologicos seriados ni en los estu‐dios tomodensitométricos. Las crisis se controlaron por com‐pleto con anticonvulsivantes.
ZUSAMMENFASSUNG
Wir untersuchten eine 41‐jährige Frau mit nächtlichen somato‐sensorischen Anfallen im Anschluß an den Orgasmus. Das in‐teriktale EEG zeigte in der linken zentroparietal Region par‐oxysmale Aktivitat, die im Schlaf deutlich zunahm. Während des Schlafes wurden 8 elektroklinische Anfälle polygraphisch auf‐gezeichnet. Der Orgasmus trat gleichzeitig mit der Generali‐sierung der paroxysmalen Aktivität auf. Die neurologische Un‐tersuchung und das CT entdeckten keine Auffalligkeit. Vollstan‐dige Anfallsfreiheit wurde durch Antiepileptika erreicht.
A case is reported of a man 60 years of age with degenerative stenosis of the lumbar canal at the L3-4 level and lumbar arachnoiditis, whose symptoms of claudication of the cauda equina were accompanied by uncomfortable involuntary erections. All symptoms were relieved by surgical decompression.
Alterations of sexual behavior are frequent and varied in patients with temporal lobe epilepsy. They are classified according to whether they occur during, immediately following, or between seizures. Other than control of seizures by anticonvulsants or surgery, no specific treatments have been developed. The author reviews studies of prevalence and treatment and considers the implications of these changes for the understanding of the neurophysiology of sexual behavior.
There has been considerable recent interest in frontal lobe epileptic syndromes, and less attention paid to occipital and parietal epilepsies. The occipital and parietal lobes have arbitrary anatomical borders. The prinicpal seizure symptomatology includes somatosensory (paresthetic, painful, thermal, sexual, apraxia, disturbances of body image); visual (amaurotic, elementary and complex hallucinations, illusions) and other phenomena (anosognosia, apraxia, acalculia, alexia, aphemia, confusional states, gustatory, vertiginous, adversive, oculoclonic and eyelid flutter). The seizure symptoms are of varying localizing and lateralizing value and seizure discharges may spread rapidly and perceived symptoms may reflect secondary spread rather than the primary site of seizure onset. Recognized parietal and occipital epilepsy syndromes include benign epilepsy of childhood with centrotemporal spikes, benign epilepsy of childhood with parietal evoked spikes, benign occipital epilepsy of childhood, migraine/epilepsy syndromes, and epilepsy with bilateral occipital calcification. In addition, occipital and parietal epilepsy may be on the basis of any underlying structural lesion. There is frequently a poor correlation between clinical and EEG features. MRI and functional imaging often reveals underlying pathology. There have been no specific trials of different antiepileptic drugs for occipital and parietal seizures. Surgical treatment has its place, with attention to the risk of causing a fixed neurological deficit.
Perception of a phantom limb is frequent after an amputation of an upper or lower extremity. Phantom penis is reported infrequently.
Case description and literature review.
The phenomenon of phantom penis followed total penectomy. Several aspects were unusual, particularly the existence with phantom only in the erect state, and associated recrudescence of a preoperative painful ulcer. General features of limb phantoms after amputation are reviewed including a résumé of recent studies of cortical reorganization. The phantom process is analyzed looking for clues to the nature of the underlying neural organization. The puzzle of phantom pain is briefly touched on.
The development of the phantom is attributed to activity in the deafferented parietal sensory cortex.
Autonomic symptoms frequently occur during epileptic seizures either as an accompaniment to other seizure symptoms or as the predominant seizure manifestation. They do not represent simple reactions to motor manifestations of seizures, but are mediated by an activation of the central autonomic network. Autonomic symptoms can be divided into cardiovascular changes, respiratory manifestations, gastrointestinal symptoms, cutaneous manifestations, pupillary symptoms, genital and sexual manifestations as well as urinary symptoms. Due to a hemispheric-specific representation of the central autonomic network, certain autonomic symptoms may provide lateralizing and sometimes localizing information on the seizure onset zone, although some of these signs may appear as a result of discharge spreading. Autonomic symptoms indicating a seizure onset in the non-dominant hemisphere include ictal vomiting and retching, spitting automatisms and ictal urinary urge. Autonomic symptoms range from subtle seizure manifestations which become apparent only during meticulous seizure analysis, to severe, sometimes life-threatening events. Cardiovascular and respiratory autonomic symptoms are discussed as the mechanisms underlying sudden unexplained death in epilepsy. When autonomic symptoms represent the sole seizure manifestation, they can pose problems for differential diagnosis of various non-epileptic conditions. Finally, autonomic seizure symptoms open a unique window on the functional organization of the central autonomic network and on brain function in general. (Published with videosequences.)
An analysis is made of problems pertaining to psychosomatic medicine the explanation of which requires the help of neurophysiology. This analysis turns the focus of attention on the question of central mechanisms of emotion. A summary is given of the work in this area that has led to investigations on the phylogenetically old cortex and related structures which collectively are referred to as the limbic system. This designation is explained in the course of presenting a short anatomical introduction to the physiological material.The rest of the article is divided into two parts. The first part deals with investigations on the localization of function within the limbic system. These studies suggest that respective portions of the limbic system are concerned with emotionally determined functions pertaining to the preservation of the self or to the preservation of the species. Neuroendocrine aspects of limbic function are included in this part.The second part presents behavioral, physiological, neuropharmacological and neurochemical findings pertaining to a postulated dichotomy in the function of the limbic and neocortical systems.As indicated in the accompanying comments, this material has important implications not only in regard to understanding differences in emotional and intellectual processes but also with respect to the psychotherapy and chemotherapy of psychological disorders.
This paper reports the result of an investigation into the hypothesis that severity of personality disturbance is positively related to the frequency of certain early adverse childhood influences.
Two cases are reported: a 36-year-old man with impotence due to a temporal lobe astrocytoma; and a 43-year-old man with impotence and epilepsy due to a posterior frontal oligodendroglioma. The clinical and neurophysiological evidence supporting the association of the limbic system with sexual function is reviewed. It is suggested that enquiry into sexual function should form part of the routine clinical history taking of patients suspected of organic cerebral disease.
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