A Strange Transformation

During an epileptic seizure, waves of abnormal electrical activity sweep through the brain. That can create some strange experiences, including hallucinations and feelings of déjà vu. Even stranger is the recently reported case of an epileptic woman who feels that she has become a man during some seizures.

In a paper in press at Epilepsy & Behavior, Burkhard Kasper and colleagues at the University of Erlangen-Nürnberg in Germany report that the 37-year-old woman's momentary gender transformations include the sense that her voice is deeper and her arms have become hairier. On one occasion, she told the researchers, a female friend was in the room as a seizure came on, and she had the sense that her friend had become a male as well.

A magnetic resonance imaging scan revealed damage to the woman's right amygdala, probably caused by a small tumor, and EEG electrodes recorded abnormal activity in the surrounding right temporal lobe, suggesting that this region is the source of her seizures.

Other than some symptoms of depression and anxiety, which responded well to treatment, the woman had no history of psychiatric illness, and she never experienced the transformation in the absence of seizures. Delusional feelings of gender transformation have been previously reported in people with schizophrenia and other psychotic illnesses, the authors write, but not to their knowledge in a person with epilepsy.

The authors wisely avoid the conclusion that there's a sexual identity center in the right amygdala, says Orrin Devinsky, a neurologist at New York University. If that were the case, one might expect that patients who've undergone surgical removal of the amygdala to treat intractable epilepsy would experience similar symptoms. But there have been no such reports, Devinsky says.

More likely, he says, the amygdala is one node in a network of brain regions essential for self-identity. When neural activity in this network goes haywire, a range of bizarre experiences can result, Devinsky says. The Russian novelist Fyodor Dostoyevsky wrote of feeling the presence of God in the moments preceding a seizure. More common, Devinsky says, are feelings of déjà vu or its opposite, jamais vu, the sense that a familiar environment has become unfamiliar. "In epilepsy, you can experience these intense and extreme emotions and in some cases misidentification of yourself and where you are in relation in the world," he says.