The fetal anticonvulsant syndrome in an adult male: a rare example of violent behaviour in the context of epilepsy related disorders

Objective: Despite the relatively high prevalence of epilepsy, the existing literature is inconclusive with respect to the association between violent or aggressive behaviours and epilepsy related disorders. Method: The present paper describes two male adult siblings with fetal anticonvulsant syndrome and a history of felonies and misdemeanours. In addition, the main epilepsy related conditions that may coincide with aggression, such as postictal psychotic states, hypothalamic hamartoma and use of anti-epileptics, are briefly reviewed. Results: For epilepsy related behaviours, brain disorders, contextual parameters, and the interictal period, as well as the behavioural pharmacology of antiepileptics and their teratogenic effects with prenatal exposure, are much more important than the epileptic fit itself. Conclusions: The clincal neuroscientist should be equipped with specialized knowledge about psychopathology related to epilepsy and anticonvulsants. Of special importance for the clinician is the awareness during the diagnostic process that prenatal exposure to anti-epileptics may be associated with prolonged behavioural disinhibition as a long-term consequence.