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Arrest For Seizure-Related Behavior Seizures are caused by a sudden malfunction in the electrical system of the brain, which has the effect of swamping part or all of the brain with an electrical overload. This in turn produces temporary changes in behavior and/or consciousness. Seizures may be convulsive or non-convulsive. A non-convulsive seizure with automatic behavior is called a complex-partial seizure, or a psychomotor or temporal lobe seizure. When a person has this type of seizure, s/he appears to be in a dazed condition, may mumble or pick at clothing, may pick up an object and put it down again, may walk aimlessly, or even run in apparent fear. During these episodes the person is on "automatic pilot" so far as his or her actions are concerned, is totally unaware of what is happening, and, when consciousness returns, will have no memory of what occurred during the seizure. After a few minutes, natural systems in the brain subdue the electrical overload which caused the seizure, and consciousness returns. The person will become responsive, but may remain confused for as much as half an hour to an hour. A major problem in the public handling of psychomotor (complex partial) seizures is recognition of the symptoms. The unusual behavior associated with complex partial seizures is often misinterpreted as stemming from intoxication. A cardinal rule in the handling of any seizure is that the person should not be restrained in any way unless it is essential for his/her personal safety. The person in the midst of a complex partial seizure may react violently to the restraint while unaware s/he is doing so. During the seizure the person is in a confused mental state, but is usually amenable to suggestions and comments made in a pleasant and friendly manner. While in a semi-conscious or unconscious state, an individual with complex-partial seizures may commit an undirected act which may be perceived as "criminal," e.g., shoplifting, disorderly conduct, etc., depending upon the characteristics of his seizure disorder. Whether an individual's alleged criminal behavior was seizure-related is a question that can best be answered by his or her neurologist. Witnesses' reports of his/her exact behavior (as well as descriptions of his/her general behavior during a seizure) will also be very helpful in determining whether s/he was in the midst of a seizure. An expert familiar with the individual and his seizures will be crucial to defend any criminal charges against him. There have been many instances in which persons having seizures have been arrested and charged with such crimes as drunk and disorderly conduct, resisting arrest, unlawful entry, even assault on a police officer. The Epilepsy Foundation (EF) brought this serious problem to the attention of the House of Representatives Judiciary Committee during hearings on the Americans With Disabilities Act (ADA). In its final report, the Committee stated: In order to comply with the non-discrimination mandate, it is often necessary to provide training to public employees about disability. For example, persons who have epilepsy, and a variety of other disabilities, are frequently inappropriately arrested and jailed because police officers have not received proper training in the recognition of and aid for seizures. Often, after being arrested, they are deprived of medications while in jail, resulting in further seizures. Such discriminatory treatment based on disability can be avoided by proper training. Information obtained from the Epilepsy Foundation of America website at www.efa.org. Epilepsy and Violent Crime The possible relationship between an epileptic seizure and criminal behavior beyond the misdemeanor level is extremely controversial. It is generally agreed among neurologists and epileptologists that well-organized, purposeful, complicated, or goal-directed behavior is highly unlikely during a seizure. In order to evaluate the rare possibility that an individual has committed a purposeful crime during a seizure, numerous variables must be considered. These include whether the individual has epilepsy, the type of seizure that person has, the type of behaviors he or she typically exhibits during a seizure, the type of behavior the individual exhibits when not having seizures, and, the most difficult to establish, a connection between the seizure disorder and its behavior and the behavior taking place at the time of the crime. The opinion of the individual's neurologist, who is familiar with his or her seizure pattern and behavior, will be very important in making this determination. A comprehensive article on the topic is Weinberg, C.D., "Epilepsy and the Alternatives for a Criminal Defense," 27 Case W. L. Rev. 77l (l977). The following book contains chapters on an alleged connection between various neurological disorders, including epilepsy, and violent behaviors: Riley, T. and Roy, A., Pseudoseizures, Williams & Wilkins, Baltimore (1982). Other articles that may be of interest include: Stevens, J. R. & Hermann, B., "Temporal Lobe Epilepsy, Psychopathology and Violence: The State of the Evidence, Neurology, Vol. 3l, pages ll27-ll32 (September l98l); Hermann, B., et al., "Interictal Psychopathology in Patients with Ictal Fear: A Quantitative Investigation," Neurology, Vol. 32, pages 7-ll (January l982); Letters to the Editor, Neurology, Vol. 32, pages 574-575 (May l982); Treiman, D. & Delgado-Escueta, A., "Violence and Epilepsy A Critical Review," Recent Advances in Epilepsy, Churchill Livingstone (l983), and Treiman, D.,"Epilepsy and Violence: Medical and Legal Issues," Epilepsia, Vol. 27 (Suppl. 2) S77-S104 (l986); Perlin, "Unpacking the Myths: The Symbolism Mythology of Insanity Defense Jurisprudence," 40 Case Western L. Rev. 599 (1989-1990); Corrado, "Automatism and the Theory of Action," 39 Emory L.J. 1191 (1990). Following is a list of cases concerning epilepsy and criminal behavior. Most of these cases involved violent acts. One case analyzing the issue is United States v. Voice, 627 F.2d l38 (8th Cir. l980). If it can be shown that a person was in the midst of a seizure (the above criteria will be important), the defense of involuntariness, an "automatism," will be available to negate intent. See also: State v. Massey, 747 P.2d 802 (Kan. 1987). A good discussion of the automatism defense (and distinguishing this defense from an insanity plea) can be found in People v. Grant, 360 N.E.2d 809 (l977), and State v. Caddell, 2l5 S.E.2d 348 (l975). See also: State v. Fields, 376 S.E.2d 740 (N.C. 1989). Cases in which epilepsy has been used as the basis for an insanity defense include: Arizona v. Vickers, 768 P.2d 1177 (Ariz. 1989); Starr v. State, 2l3 S.E.2d 53l (Ga. App. l97l); Sprague v. State, l87 N.W.2d 784 (Wis. l97l); People v. Codarre, 245 N.Y.S.2d 8l (App. Div. Sup. Ct. N.Y. l963), aff'd, 200 N.E.2d 570 (l964), cert. denied, 379 U.S. 883; Brady v. State, l90 So.2d 607 (Fla. l966); and State v. Pettay, 532 P.2d l289 (Kan. l975); State v. Wimer, 284 S.E.2d 890 (W.Va. 1981); Davies v. State, 688 S.W.2d 738 (Ark. 1985); Frazier v. State, 362 S.E.2d 351 (Ga. 1987) (Expert witness' testimony failed to establish that the defendant's brain abnormality, which might diminish his impulse control and increase his tendency to rage states, was related to his actions during the crime.) While this material is designed to provide accurate and current information on the subject matter involved, the Epilepsy Foundation and the authors cannot guarantee the accuracy or completeness of the information contained in this publication. This fact sheet is not a legal document and does not provide legal advice or opinion. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The most frequently asked questions about epilepsy This page is intended to provide the basic information about epilepsy and seizure disorders to the general public. It is not intended to, nor does it, constitute medical advice, and readers are warned against changing medical schedules without first consulting a physician. What is epilepsy? Epilepsy is a neurological condition that from time to time produces brief disturbances in the normal electrical functions of the brain. Normal brain function is made possible by millions of tiny electrical charges passing between nerve cells in the brain and to all parts of the body. When someone has epilepsy, this normal pattern may be interrupted by intermittent bursts of electrical energy that are much more intense than usual. They may affect a person's consciousness, bodily movements or sensations for a short time. These physical changes are called epileptic seizures. That is why epilepsy is sometimes called a seizure disorder. The unusual bursts of energy may occur in just one area of the brain (partial seizures), or may affect nerve cells throughout the brain (generalized seizures). Normal brain function cannot return until the electrical bursts subside. Conditions in the brain that produce these episodes may have been present since birth, or they may develop later in life due to injury, infections, structural abnormalities in the brain, exposure to toxic agents, or for reasons that are still not well understood. Many illnesses or severe injuries can affect the brain enough to produce a single seizure. When seizures continue to occur for unknown reasons or because of an underlying problem that cannot be corrected, the condition is known as epilepsy. Epilepsy affects people of all ages, all nations, and all races. Epilepsy can also occur in animals, including dogs, cats, rabbits, and mice. What is the difference between seizures and epilepsy? Seizures are a symptom of epilepsy. Epilepsy is the underlying tendency of the brain to produce sudden bursts of electrical energy that disrupt other brain functions. Having a single seizure does not necessarily mean a person has epilepsy. High fever, severe head injury, lack of oxygen--a number of factors can affect the brain enough to cause a single seizure. Epilepsy, on the other hand, is an underlying condition (or permanent brain injury) that affects the delicate systems which govern how electrical energy behaves in the brain, making it susceptible to recurring seizures. Which doctors treat epilepsy? Neurologists, pediatric neurologists, pediatricians, neurosurgeons, internists and family physicians all provide treatment for epilepsy. Specialized care for people whose seizures are difficult to control is available in large medical centers, neurological clinics at university and other hospitals, and from neurological specialists in private practice. Is epilepsy ever contagious? No, epilepsy is never contagious. You cannot catch epilepsy from someone else and nobody can catch it from you. What should I consider if there has been only a single seizure? When a child or adult has never had a seizure before, the first seizure should be followed by a careful medical evaluation to help the doctor decide whether to recommend treatment with seizure-preventing drugs, or to wait and see whether it occurs again. The most important factor in deciding whether to begin drug treatment for a single seizure is the probability of further seizures. Physicians use both diagnostic tests and careful evaluation of the seizure itself to determine how likely it is that the patient may have more seizures in the future. Age, family history, and possible causes of the seizure are among the factors that are considered. Non-medical issues, such as loss of driver's license or worries about impact on employment, may also enter into the decision. What causes epilepsy? In about seven out of ten people with epilepsy, no cause can be found. Among the rest, the cause may be any one of a number of things that can make a difference in the way the brain works. For example, head injuries or lack of oxygen during birth may damage the delicate electrical system in the brain. Other causes include brain tumors, genetic conditions (such as tuberous sclerosis), lead poisoning, problems in development of the brain before birth, and infections like meningitis or encephalitis. Epilepsy is often thought of as a condition of childhood, but it can develop at any time of life. About 30 percent of the 125,000 new cases every year begin in childhood, particularly in early childhood and around the time of adolescence. Another period of relatively high incidence is in people over the age of 65. What should I do if I suspect a seizure disorder? If you think you or a loved one might be having seizures, it is important to discuss with your physician what has been happening. Keep a record of how often the unusual episode occurs, the time of day it happens and what form it takes. Giving the doctor this information as it will help him or her to determine whether what you are describing might be a type of epilepsy. How is epilepsy diagnosed? The doctor's main tool in diagnosing epilepsy is a careful medical history with as much information as possible about what the seizures looked like and what happened just before they began. A second major tool is an electroencephalograph (EEG). This is a machine that records brain waves picked up by tiny wires taped to the head. Electrical signals from brain cells are recorded as wavy lines by the machine. Brain waves during or between seizures may show special patterns which help the doctor decide whether or not someone has epilepsy. Imaging methods such as CT (computerized tomography) or MRI (magnetic resonance imaging) scans may be used to search for any growths, scars, or other physical conditions in the brain that may be causing the seizures. In a few research centers, positron emission tomography (PET) imaging is used to identify areas of the brain which are producing seizures. How can people guard against having seizures? A person with epilepsy can help control his or her seizures by taking the prescribed medication regularly, maintaining regular sleep cycles, avoiding unusual stress, and working closely with his or her physician. Regular medical evaluation and follow-up visits are also important. However, seizures may occur even when someone is doing everything he or she is supposed to. How is epilepsy treated? Epilepsy may be treated with drugs, surgery, or a special diet. Of these treatments, drug therapy is by far the most common, and is usually the first to be tried. A number of medications are currently used in the treatment of epilepsy. These medications control different types of seizures. People who have more than one type of seizure may have to take more than one kind of drug, although doctors try to control seizures with one drug if possible. A seizure-preventing drug (also known as an antiepileptic or anticonvulsant drug) won't work properly until it reaches a certain level in the body, and that level has to be maintained. It is important to follow the doctor's instructions very carefully as to when and how much medication should be taken. The goal is to keep the blood level high enough to prevent seizures, but not so high that it causes excessive sleepiness or other unpleasant side effects.