Manic Monday (late edition): Sudden hypersexuality

Two case reports on sudden, acute, involuntary hypersexuality stemming from abnormal brain anatomy.

Cao Y, Zhu Z, Wang R, Wang S, Zhao J., “Hypersexuality from resection of left occipital arteriovenous malformation,” Neurosurg Rev. 2009 Oct 15. [Epub ahead of print] DOI: 10.1007/s10143-009-0232-2:

The authors report their experience on one patient with hypersexuality from resection of left occipital arteriovenous malformation. To the best of our knowledge, this is the first case reported in the literature. A 35-year-old right-handed female farmer suffered a sudden left occipital hemorrhage with subarachnoid and subdural hemorrhages of the left hemisphere. . . .

Arnedo V, Parker-Menzer K, Devinsky O.Forced spousal intercourse after seizures. Epilepsy Behav. 2009 Sep 28. [Epub ahead of print]doi:10.1016/j.yebeh.2009.08.005

Hypersexuality, a feature of Klüver–Bucy syndrome, is a rare but dramatic postictal symptom of temporal lobe epilepsy. We describe a 39-year-old patient with uncontrolled partial epilepsy who developed postictal periods of hypersexual aggression toward his wife after nocturnal convulsions. Following these seizures, he would have forced intercourse with his wife, followed by tremendous guilt and remorse when informed of his actions in the morning. Nocturnal convulsions and postictal hypersexuality resolved with a combination of lamotrigine and levetiracetam, more sleep, and stress management. The temporal features of the hypersexual behavior with respect to convulsions and the resolution of the behavior with seizure control support that aggressive hypersexuality can occur as a transient postictal behavioral change. The more intense nature of his symptoms compared with previously reported cases may reflect the occurrence of symptoms after tonic–clonic rather than partial seizures.

Apparently hypersexuality is not uncommon with certain types of epilepsy. This seems to be distinct from sex addiction, which would be (presumably) similar to other types of addictions in the neural-reward (or pain-relief) pathway.

The whole thing reminds me of neurodegeneration of frontal lobe white matter, where the original instinctual behaviors develop — such as fist clasping and rooting for milk.   Not suprisingly, then, hypersexuality is also not uncommon with frontemporal dementias.  E.g., Wallace M, Safer M., “Hypersexuality among Cognitively Impaired Older Adults,” Geriatr Nurs. 2009 Jul-Aug;30(4):230-7. Epub 2009 Apr 8. doi:10.1016/j.gerinurse.2008.09.001