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Unilateral Temporal Lobe Damage and the Partial Kluver–Bucy Syndrome
Unilateral temporal lobe damage and the partial Kluver-Suey syndrome
G.D.L. Bates 0
S.G. Sturman 0
0 Queen Elizabeth Psychiatric Hospital , Mindelsohn Way , Birmingham B15 2QZ and City Hospital , Dudley Road, Birmingham B18 7QH , UK
The characteristic behavioural constellation of Kluver-Bucy syndrome is believed to be diagnostic of bilateral temporal lobe damage, even in the partial syndrome. The case described is that of a 54 year old woman with gross atrophy of her right temporal lobe following neurosurgery who developed hyperphagia (with driven food-seeking behaviour), placidity and hyposexuality. Her case thereby meets criteria for the partial syndrome but without evidence of bilateral damage. The discussion covers the various presentations of hyperphagia, the significance of the symptom cluster of Kluver-Buey syndrome and the management difficulties presented by hyperphagia.
Kluver-Bucy Syndrome - Hyperphagia - Brain Damage - Food-seeking Behaviour - Organic Bulimia
INTRODUCTION
Since Kluver and Bucy's original description of the
behavioural effects of bitemporal lobectomy on
rhesus monkeys
(Kluver and Bucy 1939)
, links have
been made to human temporal lobe functioning. The
full and partial syndromes have been described in
humans though never previously with unilateral tem?
poral damage only. The lady described died 12
months after in-patient assessment as a result of
myocardial infarction presumed secondary to her
non-insulin dependent diabetes and superobesity. The
case demonstrates the problems of hyperphagia treat?
ment in addition to the complexities of the neuro?
physiology of appetite and eating behaviour.
The characteristic behaviour cluster of the Kluver?
Bucy syndrome is believed to be pathognomonic of
bilateral temporal lobe damage, even in the partial
syndrome. The case described is that of 54 year old
woman, with gross atrophy of her right temporal
lobe following neurosurgery, who developed organic
hyperphagia with driven food-seeking behaviour, pla?
cidity and hyposexuality, meeting criteria for the
partial syndrome with no evidence of bilateral
damage. She died 12 months after in-patient assess?
ment as a result of myocardial infarction presumed
secondary to her superobesity and non-insulin?
dependent diabetes. The case demonstrates the complex?
ities of the neurophysiology of appetite and eating
behaviour and the problems of the treatment of its
dysfunction.
A 54 year old right-handed, married Asian woman
was admitted for assessment under Section II of the
1983 Mental Health Act. At this time her problems
were threefold: insatiable appetite and thirst, apathy
and reduced self-care and uncontrolled non-insulin?
dependent diabetes mellitus.
She had been deteriorating at home over an 18
month period but had refused any out-patient ap?
pointments for assessment or treatment of her diabe?
tes or behavioural change despite the best efforts of
her husband and family doctor. She had agreed to
see psychiatrists at home and her compliance with
antidepressants, mood stabilizers and oral hypogly?
caemics had been confirmed by her husband. Unfortu?
nately, the extent of her hyperphagia in the context
of her diabetes had resulted in hyperglycaemia which
was life threatening. It was for this reason that appli?
cation was made for compulsory detention.
Over a 2 year period the amount that she was
eating had increased dramatically and she had put on
over 60 kg in weight. She only ate food items though
sometimes this would include raw herbs and spices.
There was no suggestion of pica.
Over the 18 months prior to admission, the woman
had spent the majority of her day in the front room
of her house eating sliced bread directly from the bag
and drinking milk by the pint. She rarely left the
room except to find food. She would continue to eat
until she vomited and then start eating again. She
had no concern for her personal hygiene and her
clothes and bed clothes were stained with vomit. The
family's attempts to limit her eating reached an extreme
when a lock was attached to the kitchen door and a
padlock to the door of the refrigerator. Eventually the
family found that the most effective strategy was simply
not to keep any food in the house although it was
extremely inconvenient to do this and she then started
to beg for food from their neighbours.
Her second problem, that of apathy and reduced
self-care, dated back at least 5 years. Psychiatric
assessment at this time recorded that she had become
very much more inert and had gradually given up all
her household duties, calling on her family to cook,
clean and attend to her wants. Her sexual relationship
with her husband, which had been previously satisfac?
tory to him, had stopped at around this time. On
mental state examination she was described as calm
and rather passive. It was recorded that her change
in behaviour was in marked contrast to her previous
character. She had worked as a headmistress in Paki?
stan and run a material shop in the (...truncated)