Here we describe the case of a patient with TEA who developed a highly specific and “creative” form of hypergraphia – compulsive versifying – after commencement of anticonvulsant therapy.Ī 76-year-old right-handed woman presented with a 5-year history of progressive impairment of episodic and topographical memory, manifesting as increasing forgetfulness for both recent and remote lifetime events and a tendency to lose her way even in familiar locations. While a substantial proportion of patients with TEA have interictal impairment of remote autobiographical memory, accelerated long-term forgetting and deficits of topographical memory and spatial navigation (Butler et al., 2007), extramnestic cognitive deficits or significant behavioral disturbance are not commonly reported. Transient epileptic amnesia (TEA) is a distinctive syndrome of temporal lobe epilepsy often accompanied by a persistent interictal disturbance of memory (Butler et al., 2007, 2009 Zeman, Boniface, & Hodges, 1998 Zeman & Butler, 2010) proposed diagnostic criteria include a history of recurrent witnessed episodes of transient amnesia, intact cognitive functions other than memory during typical episodes, and other evidence for a diagnosis of epilepsy (Zeman et al., 1998). Compulsive writing behavior, or hypergraphia, has also been associated with epilepsy and other disorders, such as tumors or stroke, affecting the temporal lobes and non-dominant hemisphere (Flaherty, 2005 Imamura, Yamadori, & Tsuburaya, 1992 Kalamangalam, 2009 Mendez, 2005 Waxman & Geschwind, 2005 Yamadori, Mori, Tabuchi, Kudo, & Mitani, 1986). Examples include pathological gambling, punding, and hypersexuality associated with dopaminergic replacement in Parkinson's disease (Joutsa, Martikainen, & Kaasinen, 2012), hyper-religiosity associated with focal temporal lobe atrophy (Chan et al., 2009), heightened visual creativity and production of art in frontotemporal dementia (Miller et al., 1998 Seeley et al., 2008), and musicophilia associated with degenerative and epileptic processes involving the mesial temporal lobes (Fletcher, Downey, Witoonpanich, & Warren, 2013 Rohrer, Smith, & Warren, 2006). Such disorders may hold insights into the brain mechanisms that mediate these behaviors. In contrast to the functional deficits commonly associated with brain damage, certain brain disorders produce excessive, abnormal, and sometimes highly specific behavioral alterations. The neural substrates of complex behaviors remain largely unknown and this is especially true of creative activities such as music and poetry (Zeman, Milton, Smith, & Rylance, 2013).
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