Compulsion to write caused by seizure, whether at work or at leisure

Hypergraphia is a compulsive or overwhelming urge to write, often associated with temporal lobe epilepsy. Influential behavioral neurologist Norman Geschwind included hypergraphia as one of the personality changes that can be observed in persons with temporal lobe epilepsy.

An unusual example of hypergraphia was observed by Dr. Mario F. Mendez, who reported the unique case of a 58 year old man who felt utterly compelled to write poetry (Mendez, 2005). The patient reported no previous history of being a poet until the age of 53, when he felt the urge to write in rhyme. He said that words are "continuously rhyming in [my] head" and felt the need to write them down and show them to other people. He didn't speak in verse, nor did he write nonrhyming prose or read others' poetry.

Thus, his condition was a very specific hypergraphia for poetry. The rhyming condition coincided with the onset of other behavioral symptoms, namely irritability and anger. Shortly thereafter he began to have partial complex seizures, which typically have foci (or origins) in the medial temporal lobes.

His seizures manifested as a sensation "rising" in his stomach followed by a brief alteration of consciousness. Seizure control with phenytoin and gabapentin ameliorated his irritability and anger but did not diminish his constant need to write in rhyme. ...

The patient underwent a repeat evaluation. On examination, he was circumstantial and somewhat viscous. He repeatedly emphasized the significance of his symptom of poetry writing, and continually responded in written poetry. Language, mental status, and neurological examinations were otherwise normal except for a slightly broad-based and unsteady gait. He had right temporal spikes on electroencephalograms and small strokes in the right thalamus and the right cerebellum on neuroimaging.

However, Mendez (2005) did not think the small right hemisphere strokes caused the patient's hypergraphia. The author was also skeptical that ongoing subthreshold ictal activity was solely responsible, because the seizures were well-controlled yet the poetry continued. Another possible explanation was related to persistent hypofunctioning in the right hemisphere, which could lead to disinhibition or "unmasking" of poetic abilities in the left hemisphere.¹ This hypothesis assumes that the right temporal lobe maintains tonic control over neural activity in the left hemisphere, so we don't all turn into Joyce Kilmer.


HYPERGRAPHIA, the movie

A notoriously hypergraphic writer of poetry and prose was Arthur Crew Inman (1895-1963), who will be the subject of Hypergraphia, a forthcoming film starring John Hurt.

Arthur Crew Inman was a reclusive and unsuccessful poet whose 17-million word diary, extending from 1919 to 1963, provides a panoramic record of people, events, and observations from more than four decades of the twentieth century.

Footnote

¹ Most people are left hemisphere dominant for rhyme generation (Krach & Hartje, 2006).


Reference

Mendez, M. (2005). Hypergraphia for Poetry in an Epileptic Patient Journal of Neuropsychiatry, 17 (4), 560-561. DOI: 10.1176/appi.neuropsych.17.4.560