Revisiting Hughlings Jackson’s dreamy state: dissociative symptoms in temporal lobe epilepsy

IF 2.3 3区医学 Q2 BEHAVIORAL SCIENCES

Epilepsy & Behavior Pub Date : 2025-08-02 DOI:10.1016/j.yebeh.2025.110623

Fiore D’Aprano , Alice Matson , Jessamae Pieters , Jacquie Eyres , Toby Winton-Brown , Terence J. O’Brien , Graeme Jackson , Sarah J. Wilson , Charles B. Malpas , Genevieve Rayner

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Abstract

Background

Transient, dissociative experiences have been attributed to temporal lobe epilepsy (TLE) since at least the time of John Hughlings Jackson in the 1870s, who described how different dissociative symptoms might have distinct clinical potential. While dissociative symptoms are well-understood as a semiological feature of mesial TLE, they can also occur interictally yet remain poorly understood. We systematically examined the frequency, nature, and clinical correlates of dissociative experiences in TLE in an initial effort to better understand their phenotypic features.

Methods

157 adults with TLE and 57 healthy controls participated (N = 214). A data-driven statistical approach determined the underlying factor structure of the Wessex Dissociation Scale in this cohort and delineated phenotypic symptom clusters. We then examined group differences in rates of dissociation symptoms, as well as the influence of epilepsy-related and mood factors.

Results

People with TLE reported more frequent dissociative experiences (M = 0.96, SD = 0.61) than controls (M = 0.69, SD = 0.38; p < 0.001). A novel five-factor solution of dissociative symptoms emerged, namely intrusive, affective, memory, somatic, and numbing. Memory blanks and somatic distortions were uniquely elevated in TLE. Memory blanks and numbing dissociative symptoms were associated with increased seizure frequency, epilepsy duration, and number of anti-seizure medications. Higher depression and anxiety symptoms were linked to elevated overall dissociative symptoms and scores on each subfactor (r = 0.26–.64; p < 0.01–<.001).

Conclusions

People with TLE experience elevated rates of dissociative symptoms in their daily lives. Rather than a general dissociative phenotype, memory- and sensory-related symptoms predominate. The data-driven five-factor model refines earlier understandings and aligns well with contemporary neurocognitive models of epilepsy as a disorder of large-scale network dysfunction, with psychological and epilepsy-specific mechanisms underpinning dissociative experiences in TLE. While the aetiology of these symptoms is complex and multidetermined, TLE nevertheless remains an insightful model for understanding the neurological basis of dissociation more broadly.

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重新审视杰克逊的梦幻状态：颞叶癫痫的分离症状

至少从19世纪70年代的约翰·休林斯·杰克逊（John Hughlings Jackson）开始，短暂的解离经历就被归因于颞叶癫痫（TLE），他描述了不同的解离症状可能有不同的临床潜力。虽然解离性症状已被充分理解为中位TLE的符号学特征，但它们也可能发生在中间，但仍知之甚少。为了更好地了解其表型特征，我们系统地研究了TLE中解离经历的频率、性质和临床相关性。方法157例成人TLE患者和57例健康对照（N = 214）。数据驱动的统计方法确定了该队列中威塞克斯解离量表的潜在因素结构，并描绘了表型症状群。然后，我们检查了分离症状发生率的组间差异，以及癫痫相关因素和情绪因素的影响。结果与对照组(M = 0.69,SD = 0.38;M = 0.96,SD = 0.61；p & lt; 0.001)。出现了一种新的解离症状的五因素解决方案，即侵入性、情感性、记忆性、躯体性和麻木性。记忆空白和躯体扭曲在TLE中明显升高。记忆空白和麻木解离症状与癫痫发作频率、癫痫持续时间和抗癫痫药物数量增加有关。较高的抑郁和焦虑症状与总体解离症状和各子因子得分升高有关(r = 0.26 - 0.64；p & lt; 0.01 & lt;措施)。结论TLE患者在日常生活中存在较高的解离性症状。而不是一般的分离表型，记忆和感觉相关的症状占主导地位。数据驱动的五因素模型完善了早期的理解，并与当代癫痫的神经认知模型很好地吻合，癫痫是一种大规模网络功能障碍，心理和癫痫特异性机制支持TLE的解离体验。虽然这些症状的病因是复杂和多因素决定的，但TLE仍然是一个有见地的模型，可以更广泛地理解解离的神经基础。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epilepsy & Behavior 医学-行为科学

CiteScore

5.40

自引率

15.40%

发文量

385

审稿时长

43 days

期刊介绍： Epilepsy & Behavior is the fastest-growing international journal uniquely devoted to the rapid dissemination of the most current information available on the behavioral aspects of seizures and epilepsy. Epilepsy & Behavior presents original peer-reviewed articles based on laboratory and clinical research. Topics are drawn from a variety of fields, including clinical neurology, neurosurgery, neuropsychiatry, neuropsychology, neurophysiology, neuropharmacology, and neuroimaging. From September 2012 Epilepsy & Behavior stopped accepting Case Reports for publication in the journal. From this date authors who submit to Epilepsy & Behavior will be offered a transfer or asked to resubmit their Case Reports to its new sister journal, Epilepsy & Behavior Case Reports.