Wednesday, 7 November 2012

Temporal Lobe Epilepsy

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Temporal lobe epilepsy
Classification and external resources

Lobe of the brain
ICD-10G40.1-G40.2
ICD-9345.4
DiseasesDB29433
MedlinePlus001399
eMedicineneuro/365
MeSHD004833
Temporal lobe epilepsy is a form of focal epilepsy, a chronic neurological condition characterized by recurrent seizures. Over 40 types of epilepsies are known.[1] They fall into two main categories: partial-onset (focal or localization-related) epilepsies and generalized-onset epilepsies. Partial-onset epilepsies account for about 60% of all adult epilepsy cases, and temporal lobe epilepsy (TLE) is the most common single form causing refractory epilepsy.[2]
Temporal lobe epilepsies are a group of medical disorders in which humans and animals experience recurrent epileptic seizures arising from one or both temporal lobes of the brain. Two main types are internationally recognized according to the International League Against Epilepsy.[1]
  • Medial temporal lobe epilepsy :(MTLE) arises in the hippocampus, parahippocampal gyrus and amygdala which are located in the inner aspect of the temporal lobe.
  • Lateral temporal lobe epilepsy (LTLE) arises in the neocortex on the outer surface of the temporal lobe of the brain.
Because of strong interconnections, seizures beginning in either the medial or lateral temporal areas often spread to involve both areas and also to neighboring areas on the same side of the brain as well as the temporal lobe on the opposite side of the brain. Temporal lobe seizures can also spread to the adjacent frontal lobe and to the parietal and occipital lobes. The causes or etiology of different temporal lobe epilepsies vary and are discussed below.

Contents

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[edit] Syndrome of Temporal Lobe Epilepsy (TLE)

The classical syndrome of TLE may begin when there is a very early insult to the left or right hippocampus that causes neuron death. Infants may develop lung or skin infections resulting in a fever. Babies have an immature thermoregulation system, and the fever causes the baby's core body temperature to increase more drastically than in adults.[citation needed] In some children, elevated body temperature can cause febrile seizures.[citation needed] Febrile seizures are relatively normal as they occur in 2-5% of children under age 5 years.[citation needed] They typically last only a few minutes or even a matter of seconds, but are neither severe motor convulsions nor followed by weakness on one side of the body. In a small number of babies, these convulsions can last for over an hour and involve repeated convulsive episodes. These are known as complex febrile seizures and may be causatively associated with TLE.[citation needed] As discussed below in the section on causes, it remains controversial whether complex febrile seizures actually cause TLE,[citation needed] or whether they are simply the earliest manifestation of the TLE condition.[citation needed]

[edit] Causes

A link between febrile seizures (seizures coinciding with episodes of fever in young children) and subsequent temporal lobe epilepsy has been suggested, but the exact role remains unclear.[3][4][5][6][7] Some studies have shown abnormalities of the hippocampus on magnetic resonance imaging (MRI) in status epilepticus, which supports the theory that prolonged seizures damage the brain.[8][9][10] Interestingly, some cases of MTLE present without the typical changes of mesial temporal sclerosis or other abnormalities on MRI scans. This has been termed paradoxical mesial temporal lobe epilepsy. The epilepsy in these patients tends to occur at a later age, which might suggest that an early event leads to hippocampal damage causing MTLE.[11][12] Although this theory needs confirmation, some studies have pointed to human herpesvirus 6 (HHV-6) as a possible link between febrile convulsions and later MTLE. Some studies suggest that HHV-6 infection happens prior to the occurrence of febrile seizures.[13][14][15][16] However, only a minority of primary HHV-6 infections may be associated with febrile seizures.[17] Secondly, other studies found HHV-6 DNA in brain tissue removed during surgery for MTLE.[18][19][20][21]
Rarely, MTLE can be hereditary or related to brain tumors, spinal meningitis, encephalitis, head injury or blood vessel malformations. MTLE can occur in association with other brain malformations. Most often, a cause cannot be determined with certainty.
LTLE is less common. It can be hereditary, as in Autosomal Dominant Lateral Temporal Lobe Epilepsy (ADLTLE) with auditory or visual features, but can also be associated with tumors, meningitis, encephalitis, trauma, vascular malformations or congenital brain malformations. Again, in many affected persons it is common that no cause can be identified.
Dispersion of granule cell layer in the hippocampal dentate gyrus is occasionally seen in temporal lobe epilepsy and has been linked to the downregulation of reelin,[22][23] a protein that normally keeps the layer compact by containing the neuronal migration. It is unknown whether changes in reelin expression play a role in epilepsy.

[edit] Symptoms

The symptoms felt by the person, and the signs observable by others, during seizures which begin in the temporal lobe depend upon the specific regions of the temporal lobe and neighboring brain areas affected by the seizure. The International Classification of Epileptic Seizures published in 1981 by the International League Against Epilepsy (ILAE) recognizes three types of seizures which persons with TLE may experience.[24]
  1. Simple Partial Seizures (SPS) involve small areas of the temporal lobe such as the amygdala or the hippocampus. The term "simple" means that consciousness is not altered. In temporal lobe epilepsy SPS usually only cause sensations. These sensations may be mnestic such as déjà vu (a feeling of familiarity), jamais vu (a feeling of unfamiliarity), a specific single or set of memories, or amnesia. The sensations may be auditory such as a sound or tune, gustatory such as a taste, or olfactory such as a smell that is not physically present. Sensations can also be visual, involve feelings on the skin or in the internal organs. The latter feelings may seem to move over the body. Psychic sensations can occur such as an out-of-body feeling. Dysphoric or euphoric feelings, fear, anger, and other sensations can also occur during SPS. Often, it is hard for persons with SPS of TLE to describe the feeling. SPS are often called "auras" by lay persons who mistake them for a warning sign of a subsequent seizure. In fact, they are actual seizures in and of themselves. Persons experiencing only SPS may not recognize what they are or seek medical advice about them. SPS may or may not progress to the seizure types listed below.
  2. Complex Partial Seizures (CPS) by definition are seizures which impair consciousness to some extent. This is to say that they alter the person's ability to interact with his or her environment. They usually begin with an SPS, but then the seizure spreads to a larger portion of the temporal lobe resulting in impaired consciousness. Signs may include motionless staring, automatic movements of the hands or mouth, altered ability to respond to others, unusual speech, or unusual behaviors.
  3. Seizures which begin in the temporal lobe but then spread to the whole brain are known as Secondarily Generalized Tonic-Clonic Seizures (SGTCS). These begin with an SPS or CPS phase initially, but then the arms, trunk and legs stiffen (tonic) in either a flexed or extended position and then clonic jerking of the limbs often occurs. GTCS are often known in the vernacular as convulsions or "grand mal" (originally a French term) seizures.
Following each of these seizures, there is some period of recovery in which neurological function is altered. This is called the postictal state. The degree and length of the impairment directly correlates with the severity of the 3 seizure types listed above. SPS often last less than 60 seconds, CPS often last less than 2 minutes, and SGTCS usually last less than 3 minutes. The postictal state in the case of CPS and GTCS often lasts much longer than the seizure ictus itself. Because a major function of the temporal lobe is short-term memory, CPS and GTCS cause amnesia for the seizure. As a result, many persons with temporal lobe CPS and GTCS will not remember having had a seizure.
Local and national laws exist regarding the operation of vehicles, aircraft and vessels by patients with epilepsy. Most licensing departments do not allow driving of vehicles by persons with CPS or GTCS until they have been seizure-free for a specified period of time. The laws are complex and varied; affected persons must check with the appropriate licensing authority. In a few locations, health care providers are legally-required to report patients with epilepsy (and other medical conditions which cause episodes of altered consciousness) to their local department of motor vehicles.[25]

[edit] Treatments

There are many oral medications available for the management of epileptic seizures. They were previously called anticonvulsants however this term is misleading because most seizures are not convulsions. The modern term is antiepileptic drugs (AEDs). In TLE, the most commonly used older AEDs are phenytoin, carbamazepine, primidone, valproate and phenobarbital. Newer drugs, such as gabapentin, topiramate, levetiracetam, lamotrigine, pregabalin, tiagabine, lacosamide, and zonisamide promise similar effectiveness, possibly with fewer side-effects. Felbamate and vigabatrin are newer AEDs, but can have serious adverse effects so they are not considered first-line AEDs. Nearly all AEDs function by decreasing the excitation of neurons (e.g., by blocking fast or slow sodium channels or modulating calcium channels) or by enhancing the inhibition of neurons (e.g., by potentiating the effects of inhibitory neurotransmitters like GABA). Unfortunately, many patients with medial temporal lobe epilepsy (up to one-third) will not experience adequate seizure control with medication.[26]
For patients with medial TLE whose seizures remain uncontrolled after trials of several AEDs (intractable), resective surgery should be considered.[27] Epilepsy surgery has been performed since the 1860s and physicians and surgeons had observed for decades that it was highly effective in producing seizure freedom. However, it was not until 2001 that a scientifically sound study was performed on the effectiveness of temporal lobectomy.[28] This study proved that after the failure of several AEDs to control seizures in TLE temporal lobe surgery is far more effective in producing seizure freedom than is additional medication trials. The unanswered question that remains is how many medications a person must fail before considering surgery. A United States sponsored research study called ERSET was begun to answer the question of whether surgery can successfully be performed early in the course of TLE. The primary outcome variable was freedom from disabling seizures during year 2 of follow-up. The study ended earlier than anticipated with a total enrollment of 38 patients. Of these, 23 were enrolled in the anti-epileptic drug (AED) treatment arm, whereas 15 received both AED treatment and surgery for TLE. The results showed that none of the patients who only received AED achieved the study endpoint; that is, none were free of disabling seizures during year 2 of follow-up. In contrast, 11 of the 15 who both received AED and surgery for TLE were free of disabling seizures (odds ratio = ∞; 95% CI, 11.8 to ∞; P < .001).[29]
In preparation for these surgeries, patients are monitored by various methods to determine the focus of their seizures (that is, the region of the brain where seizures tend to arise before spreading). This can be done with video-EEG monitoring, intracranial EEG (where electrodes are placed beneath the skull, either within or resting just outside the brain), or SPECT imaging. MRI studies may additionally be used to seek evidence of hippocampal sclerosis. Once the epileptic focus has been determined, it can be excised, which usually involves removing part of the hippocampus and often the amygdala. To avoid removing areas of the brain responsible for speech (so-called "eloquent" areas), the surgical team will conduct a Wada test pre-operatively, wherein amobarbital is injected in the left or right carotid artery to temporarily quiet one half of the brain. If the patient performs poorly on neuropsychological testing during the intracarotid amobarbital (Wada) test, the surgical team may advise the patient against surgery or may offer a more limited operation.
If a person is not an optimal candidate for epilepsy surgery, then AEDs not previously tried, the vagus nerve stimulator, or AEDs in clinical research trials might be alternative treatments.[citation needed]For children, the ketogenic diet may also be tried.[citation needed]Other possible future therapies such as brain cortex responsive neural stimulators, deep brain stimulation, and stereotactic radiosurgery (such as gamma knife) are undergoing research studies for treatment of TLE and other forms of epilepsy.[citation needed]

[edit] Social and artistic influence

[edit] Temporal Lobe Epilepsy and the Arts

Question book-new.svgThis section does not cite any references or sources. (April 2009)
As Eve LaPlante discusses in her book, Seized, the intense emotions, sensory experience including vibrancy of colors, and particular mental state provoked by temporal lobe abnormalities may have contributed to the creation of significant works of art. A number of well-known writers and artists are known, or in many cases suspected to have had temporal lobe epilepsy, aggravated, in some cases, by alcoholism. They include Vincent Van Gogh, Charles Dodgson (a.k.a. Lewis Carroll), Edgar Allan Poe, Fyodor Dostoevsky (whose novel The Idiot features a protagonist with epilepsy, Prince Myshkin), Gustave Flaubert, Philip K. Dick, Sylvia Plath and contemporary author Thom Jones. Peter O'Leary has also discussed this in relation to work of poet Philip Jenks in his "Gnostic Contagion: Robert Duncan and the Poetry of Illness". Sadi Ranson-Polizzotti has discussed the significance of Lewis Carroll's epilepsy online and in a forthcoming book on the subject.

[edit] Temporal Lobe Epilepsy, Neurotheology and Paranormal Experience

The first researcher to note and catalog the abnormal experiences associated with TLE was neurologist Norman Geschwind, who noted a constellation of symptoms, including hypergraphia, hyperreligiosity, fainting spells, and pedantism, often collectively ascribed to a condition known as Geschwind syndrome .
Vilayanur S. Ramachandran explored the neural basis of the hyperreligiosity seen in TLE using galvanic skin response (which correlates with emotional arousal) to determine whether the hyperreligiosity seen in TLE was due to an overall heightened emotional state or was specific to religious stimuli (Ramachandran and Blakeslee, 1998). By presenting subjects with neutral, sexually arousing and religious words while measuring GSR, Ramachandran was able to show that patients with TLE showed enhanced emotional responses to the religious words, diminished responses to the sexually charged words, and normal responses to the neutral words. These results suggest that the medial temporal lobe is specifically involved in generating some of the emotional reactions associated with religious words, images and symbols.
Cognitive neuroscience researcher Michael Persinger asserts that stimulating the temporal lobe electromagnetically can cause TLE and trigger hallucinations of apparent paranormal phenomena such as ghosts and UFOs. Persinger has even created a "God helmet" which purportedly can evoke altered states of consciousness through stimulation of the parietal and temporal lobes. Neurotheologians speculate that individuals with temporal lobe epilepsy, having a natural tendency to experience states of consciousness such as euphoria or samādhi, have functioned in human history as religious figures or shamans.

[edit] Temporal lobe epilepsy and hormones

Sex hormones can influence the timing and frequency of seizure activity.[citation needed] Estrogen is pro-epileptic and progesterone is anti-epileptic.[citation needed] These counterbalancing effects may account for "catamenial epilepsy" i.e. epilepsy preceding or made more severe prior to menstruation or during peri-ovulation. Gender may differentially influence neocortical pathologies in patients with refractory temporal lobe epilepsy.[30]

[edit] See also

[edit] Media Depictions

Question book-new.svgThis section does not cite any references or sources. (July 2010)

[edit] Further reading

[edit] References

  1. ^ a b Engel J; International League Against Epilepsy (ILAE) (June 2001). "A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology". Epilepsia 42 (6): 796–803. doi:10.1046/j.152a8-1157.2001.10401.x. PMID 11422340. http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0013-9580&date=2001&volume=42&issue=6&spage=796.
  2. ^ Wiebe S (May 2000). "Epidemiology of temporal lobe epilepsy". Can J Neurol Sci 27 (Suppl 1): S6–10; discussion S20–1. PMID 10830320.
  3. ^ Shinnar S, Hesdorffer DC, Nordli DR, et al. (July 2008). "Phenomenology of prolonged febrile seizures: results of the FEBSTAT study". Neurology 71 (3): 170–6. doi:10.1212/01.wnl.0000310774.01185.97. PMID 18525033. http://www.neurology.org/cgi/pmidlookup?view=long&pmid=18525033.
  4. ^ Tarkka R, Pääkkö E, Pyhtinen J, Uhari M, Rantala H (January 2003). "Febrile seizures and mesial temporal sclerosis: No association in a long-term follow-up study". Neurology 60 (2): 215–8. PMID 12552033. http://www.neurology.org/cgi/pmidlookup?view=long&pmid=12552033.
  5. ^ Dubé CM, Brewster AL, Richichi C, Zha Q, Baram TZ (October 2007). "Fever, febrile seizures and epilepsy". Trends Neurosci. 30 (10): 490–6. doi:10.1016/j.tins.2007.07.006. PMC 2766556. PMID 17897728. http://linkinghub.elsevier.com/retrieve/pii/S0166-2236(07)00209-3.
  6. ^ Berg AT, Shinnar S, Levy SR, Testa FM (November 1999). "Childhood-onset epilepsy with and without preceding febrile seizures". Neurology 53 (8): 1742–8. PMID 10563622. http://www.neurology.org/cgi/pmidlookup?view=long&pmid=10563622.
  7. ^ Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B (June 2001). "Early development of intractable epilepsy in children: a prospective study". Neurology 56 (11): 1445–52. PMID 11402099. http://www.neurology.org/cgi/pmidlookup?view=long&pmid=11402099.
  8. ^ Provenzale JM, Barboriak DP, VanLandingham K, MacFall J, Delong D, Lewis DV (April 2008). "Hippocampal MRI signal hyperintensity after febrile status epilepticus is predictive of subsequent mesial temporal sclerosis". AJR Am J Roentgenol 190 (4): 976–83. doi:10.2214/AJR.07.2407. PMID 18356445. http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=18356445.
  9. ^ Bronen RA (2000). "The status of status: seizures are bad for your brain's health". AJNR Am J Neuroradiol 21 (10): 1782–3. PMID 11110527. http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=11110527.
  10. ^ Sankar R, Rho JM (May 2007). "Do seizures affect the developing brain? Lessons from the laboratory". J. Child Neurol. 22 (5 Suppl): 21S–9S. doi:10.1177/0883073807303072. PMID 17690084. http://jcn.sagepub.com/cgi/pmidlookup?view=long&pmid=17690084.
  11. ^ Cohen-Gadol AA, Bradley CC, Williamson A, et al. (May 2005). "Normal magnetic resonance imaging and medial temporal lobe epilepsy: the clinical syndrome of paradoxical temporal lobe epilepsy". J. Neurosurg. 102 (5): 902–9. doi:10.3171/jns.2005.102.5.0902. PMID 15926717.
  12. ^ Luby M, Spencer DD, Kim JH, deLanerolle N, McCarthy G (1995). "Hippocampal MRI volumetrics and temporal lobe substrates in medial temporal lobe epilepsy". Magn Reson Imaging 13 (8): 1065–71. doi:10.1016/0730-725X(95)02014-K. PMID 8750318. http://linkinghub.elsevier.com/retrieve/pii/0730-725X(95)02014-K.
  13. ^ Hall CB, Long CE, Schnabel KC, et al. (August 1994). "Human herpesvirus-6 infection in children. A prospective study of complications and reactivation". N. Engl. J. Med. 331 (7): 432–8. doi:10.1056/NEJM199408183310703. PMID 8035839. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8035839&promo=ONFLNS19.
  14. ^ Barone SR, Kaplan MH, Krilov LR (July 1995). "Human herpesvirus-6 infection in children with first febrile seizures". J. Pediatr. 127 (1): 95–7. doi:10.1016/S0022-3476(95)70263-6. PMID 7608818. http://linkinghub.elsevier.com/retrieve/pii/S0022-3476(95)70263-6.
  15. ^ Kondo K, Nagafuji H, Hata A, Tomomori C, Yamanishi K (May 1993). "Association of human herpesvirus 6 infection of the central nervous system with recurrence of febrile convulsions". J. Infect. Dis. 167 (5): 1197–200. doi:10.1093/infdis/167.5.1197. PMID 8387564.
  16. ^ Suga S, Suzuki K, Ihira M, et al. (January 2000). "Clinical characteristics of febrile convulsions during primary HHV-6 infection". Arch. Dis. Child. 82 (1): 62–6. doi:10.1136/adc.82.1.62. PMC 1718177. PMID 10630916. http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=10630916.
  17. ^ Zerr DM, Meier AS, Selke SS, et al. (February 2005). "A population-based study of primary human herpesvirus 6 infection". N. Engl. J. Med. 352 (8): 768–76. doi:10.1056/NEJMoa042207. PMID 15728809. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=15728809&promo=ONFLNS19.
  18. ^ Yamashita N, Morishima T (October 2005). "HHV-6 and seizures". Herpes 12 (2): 46–9. PMID 16209861. http://openurl.ingenta.com/content/nlm?genre=article&issn=0969-7667&volume=12&issue=2&spage=46&aulast=Yamashita.
  19. ^ Karatas H, Gurer G, Pinar A, et al. (January 2008). "Investigation of HSV-1, HSV-2, CMV, HHV-6 and HHV-8 DNA by real-time PCR in surgical resection materials of epilepsy patients with mesial temporal lobe sclerosis". J. Neurol. Sci. 264 (1–2): 151–6. doi:10.1016/j.jns.2007.08.010. PMID 17804017. http://linkinghub.elsevier.com/retrieve/pii/S0022-510X(07)00570-9.
  20. ^ Fotheringham J, Donati D, Akhyani N, et al. (May 2007). "Association of Human Herpesvirus-6B with Mesial Temporal Lobe Epilepsy". PLoS Med. 4 (5): e180. doi:10.1371/journal.pmed.0040180. PMC 1880851. PMID 17535102. http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040180.
  21. ^ Donati D, Akhyani N, Fogdell-Hahn A, et al. (November 2003). "Detection of human herpesvirus-6 in mesial temporal lobe epilepsy surgical brain resections". Neurology 61 (10): 1405–11. PMID 14638964. http://www.neurology.org/cgi/pmidlookup?view=long&pmid=14638964.
  22. ^ Haas CA, Dudeck O, Kirsch M, et al. (July 2002). "Role for reelin in the development of granule cell dispersion in temporal lobe epilepsy". J. Neurosci. 22 (14): 5797–802. PMID 12122039.
  23. ^ Heinrich C, Nitta N, Flubacher A, et al. (April 2006). "Reelin deficiency and displacement of mature neurons, but not neurogenesis, underlie the formation of granule cell dispersion in the epileptic hippocampus". J. Neurosci. 26 (17): 4701–13. doi:10.1523/JNEUROSCI.5516-05.2006. PMID 16641251.
  24. ^ Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981;22:489-501.
  25. ^ Sample New Jersey, USA, medical report form: http://www.state.nj.us/mvc/pdf/Violations/MVC-Form_MR-4.pdf
  26. ^ Kwan P, Brodie MJ (February 2000). "Early identification of refractory epilepsy". N. Engl. J. Med. 342 (5): 314–9. doi:10.1056/NEJM200002033420503. PMID 10660394.
  27. ^ Engel J (March 1996). "Surgery for seizures". N. Engl. J. Med. 334 (10): 647–52. doi:10.1056/NEJM199603073341008. PMID 8592530. http://www.nejm.org/doi/abs/10.1056/NEJM199603073341008?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed.
  28. ^ Wiebe S et al. (2001). "A randomized, controlled trial of surgery for temporal lobe epilepsy". N Engl J Med 345 (5): 311–8. doi:10.1056/NEJM200108023450501. PMID 11484687.
  29. ^ Engle J et al. (2012). "Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial". J Am Med Assoc 307 (9): 322-30. doi:10.1001/jama.2012.220. PMID 22396514.
  30. ^ Doherty MJ, Rostad SW, Kraemer DL, Vossler DG, Haltiner AM (August 2007). "Neocortical gliosis in temporal lobe epilepsy: gender-based differences". Epilepsia 48 (8): 1455–9. doi:10.1111/j.1528-1167.2007.01046.x. PMID 17430405.
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Friday, 2 November 2012

Confessions of a Precog....


Mark Heley
psy.jpg


Although acceptance of psychic phenomena has become much wider during the last twenty years in western society, some aspects of psychic experience are still either completely ignored, or inhabit a liminal zone at the margins of psychic study. Precognitive experience is one of these. One of the significant aspects of precognition that distinguishes from it from directed psychic activity is that is involuntary. Precognition happens to the precog. Normally, the experience is unsought and the recipient is passive. Experientially it feels like an awareness shift towards incoming data and images that are coming from ‘elsewhere'.
For example, one of the more common forms of precog that I have experienced fairly often is the ‘just around the corner' type of event such as ‘seeing' a deer running onto the road around a bend that you are about to drive around. In these cases, the images are clear and unequivocal. I see the deer run onto the road in precog. I slow the car down and then as I corner the bend, I see the deer again. Only this time, the deer is just stepping onto the road because I have slowed down; it sees the car and bucks and springs away. This interests me. Where is that image coming from? I see the deer as it will be if I don't slow down, running into the middle of the road. Does that exist somewhere? Then, I respond to the image, slow down and that imminent reality changes. The deer springs away. In some senses the image I saw in precog didn't happen. In some senses, it changes what happens. And in another sense, both the precognition and the actual reality are inseparably embedded. 
I wish that when I first started having precogs about twenty years ago that I had someone I could have talked to about what was happening. Much the same as other forms of psychic ‘awakening', the awakening precogs experiences many, or all, of the symptoms of a ‘spiritual emergency' in Dr. Stanislav Grof's terminology. But whereas directed psychics (those that experience their abilities under their rational control and direction) have a much more clearly defined community and even a profession, those who experience a strong sense of precognition are much more likely to see the experience as invasive, confusing and even disturbing. I certainly did. Try explaining to a girlfriend that you are mad about something that she is going to do, but hasn't even thought about doing yet! It's not easy. And yet, for the precog the ‘fact' that the other person is going to do something, is ‘known' to the precog. There's no thinking, or speculation, involved in precognition. You either know, or you don't know. Sometimes the knowing is accompanied by images, sometimes not. It can be confusing for the 'precog' and even more confusing for those around them. I am sometimes woken instantaneously from deep sleep states by a precog. I know something. I can't do anything about that knowing, I didn't ask for it, it just happened. It can be awkward.

Once I was awoken from a deep sleep state into a total lucid awareness that a person I only knew via the internet, who was on the other side of the world, was planning to make a personal and professional attack on a teacher of mine. I emailed the teacher right away. Fortunately, the teacher was open and receptive enough to just receive the information without judgment. Within a couple of hours, the attack happened, but the forewarning meant it didn't come as a surprise and it was swiftly dealt with. I've learnt not to ask ‘what does it mean?', when I receive a precog. I just accept the incoming data and imagery without analyzing or judging it. This is because it just doesn't help to do so, this is something that is happening to me, not that I am causing to happen. This can be amply illustrated by the fact that precogs contain information that I do not, and in many cases, could not know. Analysis and judgement just tend to result in the precog being dismissed, whereas the point of precognition seems usually to be to take some sort of corrective, or anticipatory, action. This isn't always the case. Short-term immediate precogs like the deer on the road, usually result in an immediate, even sometimes reflexive action, but more general precogs that aren't specific messages to an individual relating to something happening immediately, or in the near future, often result in a change of attitude or disposition, rather than an action.

In my experience, precognitive activity is pretty much exactly how they are depicted by Philip K Dick in his masterful short story ‘Minority Report'. Events that are highly relevant in the short term to an individual, warning of unseen or unsuspected dangers, are usually very sharp, definite and image driven. Just as in the movie of the story, the precog ‘awakens' to the precognition. It can be startling, powerful, and even painful. Sometimes it comes with an accompanying adrenalin surge. On the other hand, events that are more long term and don't relate to a single individual are often more ambiguous, less literal and even ‘mythic' in their imagery. A recent precog I had was the combination of two images. One was a politician joking with an adviser about stealing the election. The other was a ‘mythic' vision of a state of stasis. I saw a series of images, rooms with dust settling on them, traffic jams at standstill, people immobilized and even paralyzed in a frozen moment of time. Am I seeing something that is literally happening? No, but as I demonstrated in the example of the deer running onto the road, this is not what is happening even in ‘ordinary' short-term precogs. What links these two seemingly different types of experience is the mode of perception. These images, emotions and information are experienced by the perceiver as entering, even taking over, the ordinary, directed mode of perception. This is something I've come to terms with now, but early on, I really didn't like this aspect of precognition. It felt weird, even a little nauseating to have one's apparently sovereign perception hijacked in this way. After a number of precogs turned out to be potentially life saving and also turned out to be absolutely accurate, I changed my disposition toward them. Now, I just pay attention. I don't dismiss them, but I don't encourage them either. In my experience, they are incoming information, my attachment to them in any way doesn't seem to be useful, or productive, so I just let them be; I pay them attention, definitely note them, even when they seem to be ambiguous or confusing.

Of course another question that the precog has to ponder is why doesn't this happen all the time? Why doesn't precognition protect me from anything bad happening at all? Why didn't I have a precog about that bag being stolen, that trip and fall in the street, even the traffic accident that causes the death of a friend? This is really quite a profound question. My conclusion is that the ordinary state of wakeful consciousness is actually a  ‘clear screen' that indicates, as Eckhart Tolle might say, that whatever is happening to us is exactly what should be happening to us for the purpose of evolving our consciousness. It may not be fun, it may not be pleasant, but it is part of the necessary life experience that we must pass through in order to evolve. In fact, I would go further than that and say that precognition is a form of temporal radar that may be constantly scanning the possibility matrix of the ‘future' and subtly adjusting and rearranging the potential futures that we interact with at a threshold below the usual state of consciousness. Then, on unusual occasions and when required, precognition erupts from this quantum ocean of the possible and invades our ordinary, directed states of consciousness.

This may seem a far-fetched and extreme rationalization of psy phenomena, but precognition raises many interesting and significant questions for theories of consciousness and, indeed, for the theories of time in physics, which precognitive phenomena seem to blatantly violate. Most of these questions are unanswered and precognition has proven a notorious difficult field of study. Whereas directed ESP phenomena can be relatively easily tested by double-blind, placebo methods, most experiments testing and assessing genuine precognitive ability would involve a lot of waiting around for something to happen.

One possibility is that precognition is merely a subset of directed psychic phenomena. When I have been traveling with a friend who is a professional psychic working for police forces in the UK doing things like hunting for missing persons, leads in murder cases, and related things, she would amuse us by nonchalantly announcing what her ‘psychic GPS' was telling her. A lot of these predictions were typical ‘around the corner' precog phenomena, like ‘be careful, there's a cyclist around the next bend.' And there always was. And this was normal, everyday experience for her. And unremarkable to us because of her nonchalance.

This seems credible, but it ignores one of the most intriguing epistemological aspects of precognition; the associated feeling that this isn't coming from ‘your' mind. The ‘otherness' of a big precognitive hit to me is palpable. It would be convenient to ignore this aspect of precognition, because it would allow the idea that psychic activity is itself a subset of conscious brain activity more credibility. This in turn would allow these experiences to be more easily viewed as congruent with most contemporary theories of mind that view consciousness as essentially a biophysical process. Unfortunately from the precog perspective, this just doesn't feel right at all. It is not as if the deer around the corner is  an archetype, or a projection. It's an image of the exact deer, in detail. There's nothing symbolic, or mythic about it. It just can't be argued away by suggesting a ‘resonant feedback loop' exists between your brain and an external reality. There's a picture of a deer in your mind and then 15 seconds later you a viewing the same deer. Any coherent theory of precognition is going to have to deal with this. Anyone who has actually experienced precognition just isn't going to buy it otherwise. That doesn't seem to be much of a problem for most researchers investigating the nature of mind. A pervasive skeptical attitude to psychic phenomena exists, at least in the west, in most academic circles. In most cases, skepticism itself seems sufficient to deflect resources away from areas that are troublesome and difficult to study. That omission may well turn out to be the Achille's Heel of modern neuroscience and consciousness research. Liminal areas like precognition repeatedly turn out to be the awkward exceptions that not only don't prove the rule, but thoroughly undermine it in the long term.

As an alternative, I suggest that any coherent theory of consciousness has to deal with the fact that consciousness is distributed throughout space and time in ways that confound the idea that it has a biophysical origin in the brain. Perhaps, indeed, consciousness is at its root a little more like precognition than the rational skeptics would ever be comfortable with. That is to say, consciousness is a localized field phenomenon that concentrates around what we call the event horizon of the present moment. From this center, it radiates in probabilistic quantum waves we call the ‘future'. And this is what we see when we have a precognitive experience. It is literally the ‘future', but it the ‘future' is no longer a place, or destination, but a partially viewable probability matrix which we are forever surfing into on the surfboard of the ‘now'.

This is a theory of mind that would horrify the 19th century empiricists, but doesn't seem so counter-intuitive in a post-quantum world.  After all, isn't it more compelling to develop a theory of consciousness that describes its actual observable qualities, rather than ignores them? If instead of building a theory of consciousness that was congruent with the dogmas of contemporary science, what if we were to build one from the human experience of consciousness outwards and see where the common ground lies? It may be that this ‘quantum theory of consciousness' is merely the next theoretical frontier in the slow motion collapse of scientific materialism.

People who use, or develop, their psychic abilities are often described as being ‘gifted', or even ‘cursed'. I think this can be a very misleading way of perceiving what is happening. It is often as if the psychic or precog is thought of as having an ‘extra', or ‘sixth' sense of perception that others, the non-psychic, don't have. Although some psychics seem to encourage this sense of specialness, I think that this is often more of a commercial dispensation than a philosophical one. To me, in my experience, what is happening to me is clearly something that is latent in all people. It is not as if the precog has an extra set of eyes. It is just that we are open -- whether we like or not sometimes -- to a different form of seeing. That what we ‘see' is not viewed as ‘real' is just a matter of opinion from those who haven't experienced precognition about what is a matter of fact for us. To understand precognition our theories of mind have to open as much as our minds do, if we are to actually describe the reality of precognition in a theory of consciousness that isn't just cherry picking the facts. At least we ‘precogs' can joke about it. Whenever a skeptic says precognition is just a projection, we'll just say "I knew you were going to say that."

Image by Lomo-Cam, courtesy of Creative Commons license.
http://www.realitysandwich.com/confessions_precog
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Psi in the News


Psi in the News

David Metcalfe  writing on Reality Sandwich, a fascinating blog   RS.
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Ethnography of the afterlife, skeptics issue UK psychics a scientific challenge, presentiment, premonitions and a heaping helping of NDE, in this edition of Psi-in-the-News:
Neuroscientist Eben Alexander’s new book, Proof of Heaven: A Neurosurgeon's Journey into the Afterlife, has drawn a lot of commentary in the mediasphere. Here is a round-up of some of the back and forth pro, con and undecided. 
On the skeptical side:
On the more open side: 

Special thanks to Tom Ruffes, of the Society for Psychical Research, for the heads up on the FMRI ‘telepathy center’ study. 
http://www.realitysandwich.com/psi_news_2
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Unveiling Isis


Gary Lachman
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The following is excerpted from Madame Blavatsky: The Mother of Modern Spirituality (Tarcher/Penguin 2012).

If there is one person responsible for laying the foundations of our modern spirituality, it is Blavatsky, and one of my aims in writing the book is to show just how important and influential this remarkable woman was. In this chapter I write about the impact and influence of Blavatsky's first book, her enormous compendium of esoteric knowledge, Isis Unveiled(1877). It's first printing sold out in a week and it has been in print ever since. Although her second gargantuan tome, The Secret Doctrine (1888), is better known, to my mind Isis Unveiled is more accessible and challenging. Blavatsky's target is the materialist, reductionist science that was establishing its strangle hold on western thought, reducing man to a well-dressed ape and the universe to a machine. Sadly, that vision of ourselves and the cosmos remains firmly in control, but with Isis Unveiled, Blavatsky struck a powerful blow against it, and started the ongoing struggle for a more spiritual view of the world, that many are carrying on today.

A central argument informing Isis Unveiled is that all of the world's religions spring from a common source, the ancient wisdom religion that Blavatsky identified with the Hermetic philosophy. This idea, of a common ancient, "primordial" origin for Christianity, Buddhism, Hinduism, and the rest, is found today in the work of the "Traditionalist" school, whose main theoretician, René Guénon, was, oddly, a strident critic of Blavatsky. The idea has a prestigious pedigree and can be found in the writings of theCorpus Hermeticum, a collection of philosophical and spiritual texts attributed to the ancient mythological sage Hermes Trismegistus, but which were most likely written circa 100-200 A.D. in Alexandria. The idea was later revived when the Corpus Hermeticum, lost for centuries, was translated into Latin by the Florentine Platonist Marsilio Ficino in 1463. Ficino and his contemporaries believed the Hermetic texts were the source of a prisca theologia, a "perennial philosophy," that dated back to the dawn of time, and this idea informed much of the art and culture that we associate with the Renaissance. In reviving this notion once again, Blavatsky was in some good company.
Such an idea seemed peculiarly apt for the time. When Isis Unveiledappeared, western consciousness had entered a kind of metaphysical black hole. Although Christianity was still a powerful presence it was fighting a losing battle against a reductive, exclusively materialist science, the conclusion of which was that the universe, and the life within it, were ultimately meaningless, an assessment it still stands by today. By this time, Darwin's "dangerous idea" had showed that we were really only "trousered apes," and all our pretentions to being something more were mere egotistical delusions. And if this wasn't bad enough, in 1865 the German physicist Rudolf Clausius had introduced the notion of entropy. Clausius had observed that over time, in a closed system, organized energy -- for example, heat -- tends to move toward a less organized, uniform state. (This is why a cup of coffee cools to room temperature.) As the "second law of thermodynamics," this suggested that eventually, the organized energy in the universe would dissipate until it formed a kind of uniform lukewarm "cosmic puddle," unable to support life. This irreversible process was known as the "heat death" of the cosmos. For all the "progress" associated with the Industrial Revolution and the nineteenth century, a sense of futility had entered things, a feeling for which can be found in Matthew Arnold's famous poem "Dover Beach," with its images of "ignorant armies clashing by night" upon "a darkling plain." The Society for Psychical Research was formed in 1882 because its members were troubled by this growing sense of cosmic inconsequence, and hoped that the study of Spiritualism and other "psychical" phenomena might help throw light on "the actual truth as to the destiny of man."
Yet while Spiritualism offered some support for the belief in a non-material reality, its nebulous pieties repelled more vigorous minds, eager for some coherent philosophy with which to challenge a science that seemed intent on undermining all human purpose. Faith was little help in his matter. What was needed was knowledge, and with Isis Unveiled, Blavatsky seemed to show that she had it on tap.

Although Darwin's figure looms over the book, her main targets are his "bulldog" Thomas Henry Huxley, and the scientist John Tyndall, the two high priests of scientific materialism. Although few historians have noted it, in Isis Unveiled Blavatsky presents the first major intellectual -- not religious -- criticism of Darwinian evolution. Credit for this is usually given to Samuel Butler, best known as the author of the utopian fantasyErewhon. In 1878 Butler published Life and Habit, the first of a series of brilliantly argued books, criticising this mechanical account of how species evolved. Butler argued that Darwin had "banished mind from the universe." Blavatsky agreed, but she had made the point first, and this alone should warrant her a secure place in the history of ideas.
Darwinian evolution, she argued, only told part of the story, the part that takes place in our current, physical world. It leaves out what happens before and after this interlude. Basing her vision on the Hermetic belief that the universe and everything in it, including ourselves, is an emanation of spirit,  Blavatsky argued that the transition from monkey to man is only part of the evolution of men and women into gods, a transformation, she added, that embraces the entire cosmos. Darwin, she said, "begins his evolution of species at the lowest point and traces upwards. His only mistake may be that he applies his system at the wrong end..." After passing through a period of necessary separation, spirit returns to itself, enriched by its voyage. Thus, as the late Theodore Roszak remarked, Blavatsky presents "the evolutionary image as the redemptive journey of spirit through the realms of matter" offering "the first philosophy of psychic and spiritual evolution to appear in the modern west."
The evolution of life, then, is not a "chance" occurrence, which "just happened" to take place because of some "accidental" combination of chemicals, and which then carried on, driven by the pressures of survival and the occasional advantageous mutation. As she says, "it is not spirit which dwells in matter, but matter which clings temporarily to spirit." Spirit (or consciousness), then, is primary, and matter a temporary means spirit employs in its work. Evolution is the basic grain of the universe itself, and opposed to the materialist vision which presents a "hideous, ceaseless procession of sparks of cosmic matter created by no one, floating onward from nowhere," and which "rushes nowhither," Blavatsky offers the Cabalistic aphorism: "A stone becomes a plant; a plant, a beast; a beast, a man; a man, a spirit; and the spirit, a God." In this scheme, "each perfected species in the physical evolution only affords more scope to the directing intelligence to act within the improved nervous system," a remark that the philosopher Henri Bergson, whose Creative Evolution (1907) similarly challenged Darwin, could have made. For Blavatsky then, mind is not "banished" by evolution, but uses it in order to develop itself. In this way, rather than oppose science to religion or vice versa, Blavatsky synthesizes the two and transcends both, in a way reminiscent of the philosopher Hegel's equally evolutionary account of spirit's journey through matter, The Phenomenology of Mind.
Isis Unveiled is such a huge work, both in size and conception, that it can be read on many levels. It is also, as most modern readers discover, not a work that needs to be read cover to cover, and perhaps the best way to approach it is by dipping in and out. From a historical perspective, from it we can learn about works that were considered important at the time but which are pretty much forgotten today. One such is The Unseen Universeby Peter Guthrie Tait and Balfour Stewart, published in 1875. This once very popular work argues that "the visible universe is not the whole universe but only, it may be, a very small part of it," an idea that physicists today are grappling with under the rubric of "dark matter." Arguing against the universe's eventual "heat death," the authors suggest that the energy of the visible universe might transfer to an invisible one, from which it emerges again in new forms, an idea that Blavatsky, with her Hermetic belief in dimensions of reality beyond the sensory, embraced, and which was later revived by the poet Rilke. On a biographical note, we discover that HPB was impressed with a work by a Civil War hero, General A. J. Pleasonton, The Influence of the Blue Ray of the Sunlight, and because of it she had blue glass windows and blue draperies installed in her apartment in New York's Hell's Kitchen. Pleasonton believed that blue light was particularly helpful in plant growth and that it was able to eradicate many illnesses. His work is seen as the beginning of chromotherapy -- the idea that certain colors affect health -- and HPB was not alone in putting it into practice. Around the time of Isis Unveiled there was a "blue glass" craze in America, with many people following Pleasonton's example, and using blue glass in their hot houses and for personal ailments.
It should also come as no surprise that many of the themes and ideas that occupy a great deal of contemporary "alternative" literature, were first announced by Blavatsky. When she asks her readers, "Do not the relics we treasure in our museums -- last mementos of the long lost arts -- speak loudly in favour of ancient civilizations?" We are unavoidably reminded of Graham Hancock's many works on just that theme. When she tells us that "ages before [Columbus] clove the western waters, the Phoenician vessels had circumnavigated the globe and spread civilization in regions now silent and deserted," and asks who "will dare assert that the same hand which planned the pyramids of Egypt...did not erect the monumental Nagkow-Wat of Cambodia," we think of Charles Hapgood's ideas about a "prehistoric" maritime civilization, that encircled the globe. Even Erich von Daniken, who wrote of "ancient astronauts" and the science of earlier civilizations,  is upstaged: "At a period far anterior to the siege of Troy, the learned priests of the sanctuaries were thoroughly acquainted with electricity and even lightning conductors."
An attentive reader familiar with other works of modern esotericism soon also sees how much in later systems is rooted HPB. While a student of Gurdjieff's "work," I repeatedly ploughed through his own gargantuan masterpiece, Beelzebub's Tales to His Grandson, and one idea that baffled me was the notion that "the sun neither lights nor heats." Gurdjieff, we know, criticized HPB but he was not beyond borrowing from her, and the same notion can be found in Isis Unveiled. (Its original source is the Pythagorean notion of the spiritual "central sun," of which our physical sun is only a reflection.)
Gurdjieff also spoke about the law of "reciprocal maintenance" at work in the cosmos. HPB speaks of "...the reciprocal relations between the planetary bodies." And when Gurdjieff told Ouspensky that wars were the result of "tensions" between two planets, Blavatsky told her readers that "certain planetary aspects may imply disturbances in the ether of our planet, and certain others rest and harmony." Indeed, for HPB, the planets and other stellar bodies so influence life on the Earth, that at one time they promote periods of withdrawal -- "monasticism and anchoritism" -- and at others frenzied action and "utopian schemes." This seems a pre-echo of Gurdjieff's gloomy assessment of mankind's inability to "do," our complete mechanicalness and "sleep."
Gurdjieff, of course, wasn't the only one to borrow from the Madame. Some time ago I wrote an article for the sadly defunct Gnosis magazine, about Rudolf Steiner's odd idea that the Earth was "dying," in preparation for its evolution to a higher planetary level, and how developing our own inner worlds helps this process along. Although, like Gurdjieff, Steiner was often critical of HPB, he nevertheless seems to have picked up this idea from her. Blavatsky asks "...who is able to controvert the theory...that the earth itself will, like the living creatures to which it has given birth...after passing through its own stage of death and dissolution, become an etherealized astral planet?" Gurdjieff, too, talked about the Earth "evolving" into a sun, and the moon "evolving" into an Earth, along what he called the "Ray of Creation."  And, as already mentioned, Steiner's "Anthroposophy" -- the "wisdom of man," as opposed to that of the gods -- is in many ways a western, intellectualized version of HPB's basic teachings.
But even a reader coming to these ideas for the first time is sure to learn something from HPB's vigorous, often torrential accounts of what modern science is unable to fit under its narrow rubric. Arguments for mesmerism, hypnosis, precognition, psychometry (the ability to "read" an object's past simply from touching it), the science of the ancients (which in many ways anticipates our own), the cyclical theory of history (well in advance of Oswald Spengler's Decline of the West), elementals, the evolution of the planets, the unity of all religions, prehistoric civilizations, animal reincarnation (she believed many animals were more deserving of this than many humans), magic, and much, much more, are all presented in a robust, exuberant manner that often leaves the reader dazzled. The central message is that the dull, dead, mechanical universe, that a triumphant modern science was applauding as the height of human consciousness, was, quite simply, false, and that the world was an infinitely more mysterious, more fascinating, and more alive place than what the Huxleys, Tyndalls, and others believed. The ancients knew this, and built a deeper, more profound science on that belief, a science that Blavatsky was here to revive.
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