Interictal behaviour in temporal lobe epilepsy.

which may leave permanent neurological abnormalities. These have been documented in 898 former prisoners of war in the Far East.3 Malnutrition may be associated with several different neurological syndromes, although the exact aetiology remains to be established. Under such circumstances multiple deficiencies are common. Experimentally induced deficiency of a single dietary constituent does not produce exactly the same disease as that associated with malnutrition. Peripheral neuropathy, with or without symptoms such as burning feet, amblyopia, or deafness, was the commonest manifestation of nutritional neuropathy. The incidence of residual optic atrophy and deafness was surprisingly low (4%), and residual symptomatic peripheral neuropathy was seen in nearly as many (3%), half of whom had persistent "burning feet." Abnormal neurological signs without symptoms were found in a similar number. Although there have been few detailed pathological studies of patients with a history of nutritional neuropathy, extensive degeneration of the distal ends of fibres in the posterior columns has been found.4 Thus persistent neuropathy is likely to be due to central distal axonopathy. The degree of peripheral axonopathy has not been assessed. These former prisoners of war are reaching an age when the common degenerative changes of old age are likely to occur. Probably these will be more severe than in their contemporaries, since their neurological reserve may be less. For example, cervical spondylosis causing damage to posterior column fibres will produce a much greater clinical deficit if a proportion of these fibres have already degenerated. The possibility of previous neuronal damage must be taken into account when seeking the cause of apparently new neurological problems in former prisoners of war. Spencer PS, Schaumburg HH. Central-peripheral distal axonopathy-the pathology of dying-back polyneuropathies. Over the years our concepts of the types and frequency of interictal psychopathology associated with epilepsy have changed.' 2 In the last century the dominant view was that both the intellect and the personality deteriorated on a genetic basis-a concept influenced by Morel's degeneracy theory of mental disorder.2 3 At the turn of the century the concept of the "epileptic personality" gradually gained ascendency, only to recede with the studies of Lennox4 showing that most epileptic patients were normal mentally. These findings have been confirmed by modem epidemiological studies which suggest that only one third of patients have recognisable interictal psychological disorders,5 a prevalence similar to that in patients with other chronic cerebral disorders.6 In 1948 Gibbs et a17 reported that patients …