The patient’s local neurologist recommended carbamazepine. Weperformed a video/EEG study and recorded several not quite similarnighttime seizures followed by awakening. There was no ictal epi-leptic activity; an interictal epileptic focus was noted in the rightfrontotemporal region. Thus, we decided to perform a polysomnog-raphy (PSG) study, during which we successfully recorded anotherfour seizures quite similar to the previous ones. The hypnogramwas interrupted, and sleep continuity was lost and sleep stages werealtered. Neither sleep apnea nor periodic limb movement syndromewas found to be the trigger for awakening. The reason for the wakeperiods is not clear. Several short periods of somniloquy were re-corded. Daytime sleepiness and tiredness were the main problemsof the patient. There were no specific findings on brain MRI scans.It is also important that a family member, the patient’s wife, partic-ipated in the night seizures as a caregiver. Although she did not un-dergo PSG, we thoroughly understand the reasons for her sleepinterruptions and can explain her daytime tiredness. Both the pa-tient and his wife completed the Quality of Life, Quality of Sleep,and PRIME-MD PHQ-9 questionnaires.

Results: The patient was diagnosed with recent nighttime frontalepileptic seizures after a long seizure-free period. Add-on therapywas recommended. The decrease in the number of nighttime sei-zures was followed by improvements in the quality of life and sleepof both the patient and his wife. The patient’s depression is alsoimproving. No medication was needed. We plan to perform a pro-spective study of the families of patients with nighttime seizures.

Conclusions: The origin of nighttime seizures is not always clear atfirst. Video/EEG and video/PSG can be successfully combined, andthe results help not only the patient but family members as well.Medication and family background help to stabilize the patient’scondition.

doi:10.1016/j.yebeh.2010.01.100

Topic 4. Cultural and spiritual aspects

76. Homicidal behavior and patients with epilepsy admitted atIbin-Al-Haitham High Secure Unit, Al-Rashad Teaching Men-tal Hospital, Baghdad

Naamah Sh. Humaidi, Jameel K. Muslim, Al-Rashad Teaching Mental Hospital, Baghdad,Iraq

Objectives: It is generally thought that epilepsy does not predis-pose subjects to homicidal behavior. However, many previous stud-ies have suffered from notable methodological weaknesses. Inparticular, obtaining comprehensive study groups of violent offend-ers has been difficult. Iraqi police have been able to solve an increas-ing percentage of homicides during the last few years with thegradual rebuilding of the infrastructure of the police and judicial sys-tems; these bodies totally collapsed after the fall of previous regime.Because most homicidal offenders were subjected to intensive foren-sic psychiatric examination, we were able to obtain data for 118homicidal offenders admitted to the Ibin-Al-Hiathim Secure Unit atAL-Rashad Teaching Hospital, Baghdad during the period July 2003to July 2008. The goals of this study were to (1) determine the per-centage of 118 homicides committed by people with epilepsy; (2)study the sociodemographic characteristics of people with epilepsyaccused of homicide; and (3) determine the characteristics of thevictims of people with epilepsy admitted to the Secure Unit.

Methods: In this retrospective study, files were thoroughly exam-ined to determine who had epilepsy and their characteristics, allaccording to DSM-IV criteria.

Conclusions: Forty-four percent of the subjects had abnormalEEGs. Six percent of the subjects had epilepsy. Fifty-seven percentof those with epilepsy were in the age range 20–40. There were moremales than females, probably because males are more liable to breakthe law. Most of the offenders were urban dwellers, probably be-cause there is greater access to psychiatric institutions and servicesin urban environments. The victims were mostly first-degree rela-tives of the offenders.

doi:10.1016/j.yebeh.2010.01.101

77. The transcultural concept of epilepsy in traditional beliefs

M. Darghal, Medical Center Diour Jemaa, Rabat, Morocco(P)

The prevalence of epilepsy is 1.1%. But despite the high number ofpatients, epilepsy is still unknown and care is lacking. The truthabout this disease has too long remained mysterious. Traditionalbeliefs reinforce the public on the idea that epilepsy is a diseasecaused by evil spirits. In addition, the Moroccan words used todescribe this evil are revealing: jnoun, maskoun, krina, msalmin, lad-am, riah.

Unfortunately these beliefs are behind the delay in diagnosingthe disease and hence the greater debilitation and poor social inte-gration of the patient. This is very expensive. The stigmas associatedwith epilepsy are very numerous. Sometimes patients suffer muchmore than their disease. Sometimes it is claimed that epilepsy is con-tagious, that patients with epilepsy are abnormal, dangerous, men-tally retarded, or even doors misfortune. All these ideas are falseand exacerbate the isolation of patients with epilepsy. Epilepsyaffects people of all ages but especially children and adolescents,and because of the weight of prejudice and delay in diagnosis, thesepatients remain out of the cycle of school, vocational training, andsocial life (marriage. . .) and are completely marginalized. The scien-tific advances in recent years have made it possible to improve theplight of persons with epilepsy. The anxiety generated by the onsetof the crisis can lead to emotionally dependent relationships withparents and inhibit the acquisition of emotional or intellectualautonomy of a child or young person. These difficulties in autonomymay themselves be a source of pain or symptoms (emotional imma-turity, self disorders, disturbances, aggressiveness) The loss of self-control during the crisis and dependence on others cause an injurythat, in turn, affects self-confidence. Thus, the real trauma of the dis-ease in addition to the psychological trauma deserves to beconsidered.

doi:10.1016/j.yebeh.2010.01.102

78. The work of a free epilepsy clinic in the community

Ayesha Maqbool, Khalid Mufti, Haroon R. Chaudhry

FLAME (First Liberated Action Movement Against Epilepsy) hasrun an epilepsy clinic for the last 25 years at Ahabab Hospital, RaviRoad, Lahore. This unit deals with a wide range of issues faced bypeople with epilepsy, for instance, in education, employment, trans-port, childcare and psychosocial factors affecting the family with amember or members suffering from epilepsy. Each week 300patients receive pharmacological and psychological treatment byattending this facility.

As an important component of FLAME’S objectives the commu-nity education program rapidly creates an awareness of epilepsy,its consequences and treatment among the people. The information

Abstracts / Epilepsy & Behavior 17 (2010) 579–620 601

successfully spreads through referrals from old patients, neighbors,teachers, media and general practitioners.

Annual community education programs have been organized forthe families of patients with epilepsy for the last several years. Over500 family members participate annually in these programs from allover the country.

Panels of experts attend these meetings, highlighting differentaspects of epilepsy, like the drug treatment of epilepsy, career selec-tion, education, marriage, pregnancy, nutrition and other socialissues important to patients with epilepsy. Eminent experts, recov-ered patients and their family members address these meetings.

As an impact of the valuable efforts of FLAME, the number ofpatients attending the facility at Ahbab Hospital increases daily: eachweek, more than 100 new patients visit the facility. Patients whohave never received treatment have started to come to the clinicfor treatment and follow-up. Ahbab Hospital has become well knownin the community and renders services free to people with epilepsy.

The objective of this initiative is to improve and develop strate-gies for prevention, early detection, diagnosis and management ofepilepsy in our country. We hope to revolutionize the way peoplethink about epilepsy and its effects in our lives, thus ensuring anenlightened future for the next generation.

doi:10.1016/j.yebeh.2010.01.103

79. Religious experiences as a psychotic background of an epi-leptic frontolimbic dysbalance

V.P. Samokhvalov 1, O. Samokhvalova 2, 1 Department of Psychiatry, Crimean MedicalUniversity, Simferopol, Ukraine, 2 Psychiatricka lecebna Lnare, Lnare, Czech Republic

Objective: A.A. Pontius (1981–2002) has described inclusion andexclusion criteria for limbic psychotic trigger reactions (LTPR) whichlead to criminal and homicidal actions caused by a fronto-limbicdysbalance. These conditions are differentiated schizophrenic psy-chosis, dissociative organic psychoses and epileptic psychoses. Thepurpose of this research was to determine the meaning of religiousexperience in the structure of LTPR.

Methods: Follow-up records (1–20 years) and clinical and EEGstudies of six patients were reviewed. All patients were men. Ageat onset ranged from 23 to 30 years of age. Three patients combinedhomicides and religiousness in the style of pseudo-Christianity andshamanism, and three patients were atheistic.

Results: Our study shows that the adaptive alternative of homi-cidal and destructive behavior of patients with the same character-istics and confirmed EEG paroxysmal data are religiousexperiences, which can be considered the constraining mechanismof paroxysmal limbic aggression.

Conclusion: Neuroethologically religious experiences are a ‘‘fron-tal’’ cortical answer to a limbic dysbalance.

doi:10.1016/j.yebeh.2010.01.104

80. Introducing a visual art intervention model for stress reduc-tion and the development of coping mechanisms for clientswith epilepsy

J.R. Botha, School for Communication Studies, North-West University, PotchefstroomCampus, Potchefstroom, South Africa

Objective: The research related to the topic as stated above fo-cused on three distinct objectives: The primary objective was thedevelopment of a theoretical and practical model for the use of artinterventions with clients suffering from epilepsy. The secondary

purpose was the effort to contribute to the existing body of workdone by Malchiodi (Handbook of Art Therapy, 2003) and others inthe field of art interventions or art therapy, by emphasizing an areaof research that has until now been grossly neglected. A final goalwas to reduce stress, facilitate clients’ understanding and acceptanceof the epileptic condition, and provide a platform to deal with it in apositive way.

Methods: The program was subdivided into theoretical and prac-tical components. During the first contact sessions clients werescreened for exclusion in order to avoid those who would perhapsbe unable to handle exposure to unwanted stress caused by the pro-gram (using an adapted Beck stress inventory), and to determine theexisting levels of understanding of the clients’ perceptions of theircondition. The next step, embedded in a narrative and theoreticalpoint of departure, exposed the client to historical contexts of epi-lepsy within art works and artists, followed by further interviews.In the practical context of the suggested program, a variety ofhands-on exposures to art creation were implemented, results dis-cussed analytically with both client and client support, with sugges-tions for further interventions during follow-up contact sessions, orinterventions at home, school or other (work) environments.

Results: During application of the model, preliminary findings inongoing research related to the topic have produced satisfactory re-sults in both the theoretical and practical components. Further out-comes have shown a positive isomorphism with art works andartists chosen as the historical basis of this model. The practical artinterventions showed limitations and shortcomings of the model,especially as indicated by cultural and age differences of clients.

Conclusions: Initial findings show that art intervention has beenwelcomed by practitioners in the field, but point to a need for furtherresearch and a broadened base with a particular need for strategicexperimentation beyond cultural barriers. Furthermore, an addeddimension of greater distinction and refinement of the programexposure to younger children is indicated.

doi:10.1016/j.yebeh.2010.01.105

81. Epilepsy in frescoe paintings in the hospital and church of themedieval Serbian Dechani Monastery

N. Jovic, Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia

Serbian medicine of the Middle Ages developed under the influ-ence of Byzantine and Western medicine.

Hospital: The hospital in Dechani Monastery was founded by KingStefan Urosh III Nemanjic (1322–1331). His biographer GregoryCamblak left a description of this Hospital. It was similar to the Byz-antine hospital in Pantocrator Monastery in Constantinople (XII thcentury) and took in patients suffering from epilepsy (‘‘clergymen’sdisease’’), lepers, paralytics and those with diseases of the lungs.The epileptic group also included subjects with some other seriousnervous disorders. The hospital was managed by a doctor and orga-nized as a medical institution, not as a shelter for the deprived andhandicapped. It was closed from 1745 to 1765 after being devastatedby the Turks and Albanians.

The church in the Dechani Monastery was dedicated to theAscension of the Lord Christ and constructed from 1327 to 1335.Fresco painters created, ca.1340, one of the largest cycles of Christ’smarvelous miracles in Serbian and Byzantine medieval religious art.Cycles of 22 frescoes pictured neuropsychiatric disorders (epilepsy,psychotic behavior, paralysis, muscular atrophy post stroke hemipa-resis), medical conditions (leprosy, blindness and deafness, ascites or‘‘water disease’’, metrorrhagia), and distraught patients. Miraculousrecovery of people with epilepsy was twice presented, including an

602 Abstracts / Epilepsy & Behavior 17 (2010) 579–620