Background:  Violence has been associated with epilepsy and several factors have been implicated in this association. These could be related to the seizures itself or due to a combination with factors like genetic, psychiatric, drug related or psychosocial. These behaviors often manifest in the different forms and are triggered by different risk factors across the lifespan.
Methods:
We describe a 5 patients with epilepsy who presented with aggressive behaviors where role of EEG was vital in further management.
Results:
The first is a child with learning disability and symptomatic generalized drug resistant epilepsy who was started on Levetiracetam. Within a few months of this she presented with aggressive behaviors causing significant trauma to carers leading to hospitalization. An urgent EEG supported forced normalization phenomenon which lead to aberrant behaviour. The EEG result helped in titrating her drug therapy when better control of behaviour was achieved.
The second patient is a 5y old boy with temporal lobe dysembryoplastic neuroepithelial tumor who had focal onset impaired awareness type of seizures with aggressive automatisms captured by presurgical videotelemetry. His abnormal behaviors were relieved after lesionectomy and he has remained seizure free for the past year.
The third is a young adult with bitemporal epilepsy due to post-herpes encephalitis where resistive physical and verbal abuse was recorded in the post ictal confusion phase and peregrination behaviour during videotelemetry. Expression of suicidal ideas in this phase helped to institute preventative strategies to avert self-injury.
The fourth   patient was adult admitted with postictal psychosis who was found in the driver’s seat of a car on the road in an obtunded state. He was initially discharged and then readmitted with abnormal aggressive behaviors and EEG was requested to exclude nonconvulsive status. While he was admitted to hospital he caused serious damage to hospital property and personnel.
At the end will highlight a 60y old lady with subacute encephalopathy with seizures in alcoholics which was diagnosed due to classical EEG and MRI findings after she presented with history of multiple fractures due to recurrent violent behaviors.
Conclusion: Therefore the origins of violent behaviour in patients with epilepsy are multifactorial and respond to the interaction of several factors which can modify the human behaviour. These could be due to underlying brain dysfuntion to postictal delirious and psychotic states and rare cases of ictal aggression. Neurophysiologists can play an important role to unravel this puzzle for optimizing management.