Patients with epilepsy often show psychiatric symptoms.　The underlying mechanisms of their psychiatric symptoms consist of 1） basic brain functional disorder resulting in epilepsy, 2） direct effects of epileptic seizures and 3） various psycho-somatic effects during long-term course of illness.　Antiepileptic drugs influence all these mechanisms by various ways.　These are summarized as follows:1） direct effects by the drug per se, 2） increase or decrease in frequency of epileptic seizures by the drug and 3） individual vulnerability to psychiatric symptoms.　In order to reduce the occurrence of psychiatric symptoms, we should take into account characteristics of the drug and the individual vulnerability in selecting these drugs.　Administration of antiepileptic drug should begin with minimal doses and be slowly titrated.　In order to detect psychiatric symptoms promptly, we should give information about possible psychiatric symptoms to each patient in advance.　In case of appearance of psychiatric symptoms, we should first consider the negative effects of prescribed antiepileptic medication.

The historical transition of interictal psychosis is examined from the perspective of recent development and the data from our clinical experience.　High frequency of the interictal psychosis cannot be explained by simple antagonist hypothesis between epilepsy and psychosis or their coexistence.　Until now, the cause of the interictal epilepsy has been focused on exclusively in terms of epilepsy and and other organic brain disorders.　However, recently genetic and other general causes of mental illness have received attention.　The high frequency of this illness is considered based on the different susceptibilities to mental illness in combination with epilepsy and brain damage.

Purpose:In pharmacotherapy for developmental disorders, not only anti-psychotic drugs, but these drugs in combination with anti-epileptic drugs are effective for behavioral and psychiatric symptoms.　Until now, evidence of pharmacotherapy for developmental disorders associated with epilepsy has not been established.　We evaluated the EEG abnormalities and usefulness of anti-epileptic drugs in developmental disorders.

Method:A total of 220 patients were included in this study.　We examined the therapeutic effect of behavioral and psychiatric improvement.

Results:EEG abnormalities were present in 76% of subjects, epilepsy with complicated symptoms in 40% and sleep disturbance in 34%.　Almost all patients showed EEG abnormalities on the frontal areas.　EEG abnormalities in the frontal lobe seemed to be associated with high behavioral and psychiatric symptoms, with lower inhibitory control.　Almost all patients combining anti-psychotic drug with anti-epileptic drug therapy showed improvement.

Conclusion:Anti-epileptic drugs are effective in developmental disorders with EEG abnormalities.　In cases of EEG abnormalities, anti-epileptic drugs may be an alternative treatment in developmental disorders.

Loss of consciousness （LOC） is the cardinal symptom in epilepsy, which profoundly affects ADL of the patients with epilepsy.　Recent introduction of ictal SPECT and fMRI is helpful for elucidating neural mechanism of LOC in epilepsy.　In temporal lobe epilepsy, ictal SEPCT studies disclosed not only an increase in cerebral blood flow at the medical temporal lobe structures of seizure onset and ipsilateral basal ganglia but also a decrease in frontal and parietal association cortices, the latter of which may be related to the neural mechanism generating LOC during complex partial seizures.　Studies using electrical cortical stimulation and functional brain imaging have also revealed neural correlates of some of experiential seizures:alteration in the content of consciousness such as déja-vu sense of presence, and out-of-body experience.　Epilepsy may also affect higher cognitive functions related to physical, mental, cognitive and social aspects of self-consciousness.

Instances of bilateral total or partial loss of a lobe are rare in human pathology.　In this report, non-degenerative cases with bilateral temporal damage as well as bilateral parietal and bilateral frontal lobe damage are described.　A case with bilateral temporal damage presented with severe semantic memory deficits, suggesting the temporal lobes are involved in object recognition.　A case with bilateral parietal damage showed Bálint-Holmes syndrome, or severe visuospatial defects, suggesting the parietal lobes are related to visuospatial cognition, which is basic information for movement.　Those with total or pre-total prefrontal cortex lesions showed dependency to external stimuli, release phenomenon and stereotypical behaviors, reflecting the frontal lobe’s involvement in making plan and goal-directed behavior as well as divergent thinking.

Frontotemporal lobar degeneration （FTLD） is clinically classified into frontotemporal dementia （FTD）, semantic dementia （SD） and progressive non-fluent aphasia （PNFA）.　The initial symptoms of these diseases lack characteristic features, so their early diagnosis is difficult.　This study aimed to presents FTLD cases using the actual image and sound focusing on distinctive language symptoms.　Case 1 exhibited symptoms of typical FTD with observed compulsive and inappropriate behaviors along with confrontation naming.　Case 2 was considered PNFA, and exhibited apraxia of speech as a core symptom along with mild dysarthria and aphasia.　Case 3 exhibited the symptoms of typical SD.　He spoke fluently and frequently asked “what is ～?”.　He had impaired confrontation naming, single-word comprehension and exhibited surface dyslexia in Kanji ideograms.　When characteristic symptoms of FTLD are exhibit, accurate early diagnosis and understanding of symptoms are important.

Chronological changes and discrepancy factors in language-cognitive impairments and communication activity limitations were investigated in 13 patients with aphasia.　Aphasia Quotient （AQ） and Cortical Quotient （CQ） scores from the Western Aphasia Battery （WAB） and the short form of Communicative Abilities of Daily Living （short CADL） were used to assess language function, cognitive function, and communication activities, respectively.　The results showed improvements in language function, cognitive function, and communication activities;however, compared to communication activities, there was less improvement in language function over time, especially in spontaneous speech, suggesting a possible dissociation between language function and communication activities.　In contrast, there was no difference in improvement of cognitive function and communication activities.　The contributing factor was believed to be improvements in basic compensatory reactions such as a reading, writing, and construction.　To determine the involvement of compensatory reactions in communication activity limitation, the patients were divided into two groups based on the amount of increase of compensatory reactions, and the scores for AQ of the WAB and the short CADL scores were compared.　The results indicated a significant difference in short CADL scores between the two groups, suggesting increased compensatory reactions, such as pointing and writing, used spontaneously by aphasic patients improved communication activity limitations.　The findings of the current study suggest there is a need to develop appropriate compensatory and alternative measures appropriate for the level of cognitive impairment of each patient to improve communication activity limitations.