The demographic, clinical and forensic profile of offenders diagnosed with epilepsy referred to the Free State Psychiatric Complex Observation Unit in terms of section 77 and/or 78 of the Criminal Procedure Act 51 of 1977

Limited information regarding the relationship between psychopathology associated with epilepsy, crime and the legal aspects thereof is available in South Africa. Objectives. The demographic, clinical and forensic profile of alleged offenders diagnosed with epilepsy and referred to the Free State Psychiatric Complex Observation Unit from 2001 to 2006 was investigated. Design. A retrospective cross-sectional study was conducted. Results. Of the 69 alleged offenders aged 17 - 79 years (median 30 years), 94.2% were male, 81.2% black, 72.5% single and 69.9% unemployed. The median level of education was grade 6. Offences were violent in nature and committed against a person in 75% of cases. There was a direct link between epilepsy and the alleged offences in 7% of cases. Generalised epilepsy (34.8%) and interictal psychosis (20.3%) were the most commonly diagnosed conditions. Twenty-nine alleged offenders (42%) lacked criminal responsibility and were not fit to stand trial. Most observati (79.2%) diagnosed with generalised epilepsy were criminally liable and fit to stand trial. The highest rate of criminal incapacity was found among observati with interictal psychoses (85.7%) and co-morbid mental retardation (90%). Almost 60% of referred cases were declared as state patients by the court. Conclusion. In only 16% of cases, observati were found unaccountable because of epilepsy (automatisms) or postictal confusional states. Our findings confirmed an increased prevalence of violent behaviour during seizure-free periods. This contributes to the evidence that factors associated with epilepsy, rather than epilepsy itself, play an important role in the possible increased risk of violent behaviour in people with epilepsy.