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Managing aggression in epilepsy

  • Hesham Y. Elnazer and Niruj Agrawal


Behavioural changes associated with epilepsy can be challenging for patients and clinicians. Evidence suggests an association between aggression and epilepsy that involves various neurophysiological and neurochemical disturbances. Anti-epileptics have variable effects on behaviour and cognition that need consideration. Early detection and careful consideration of history, symptomatology and possible common comorbid psychiatric disorders is essential. Appropriate investigations should be considered to aid diagnosis, including electroencephalogram (EEG), video EEG telemetry and brain imaging. Optimising treatment of epilepsy, treatment of psychiatric comorbidities and behavioural management can have a major positive effect on patients' recovery and well-being.

Learning Objectives

• Understand the epidemiology of aggression in epilepsy

• Comprehend the link between anti-epileptics and aggression, including the important role of pharmacodynamics

• Be aware of the pharmacological treatments available for managing aggressive behaviour in epilepsy

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Corresponding author

Correspondence Dr Hesham Y. Elnazer, St Andrews Hospital – Kemsley, Cliftonville road, Northampton, NN1 5DG, UK. Email:


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Declaration of Interest



See Box 1 for definitions of some of the epilepsy-related terms used in this article.



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Managing aggression in epilepsy

  • Hesham Y. Elnazer and Niruj Agrawal
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