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An example of what hypergraphia may look like

Hypergraphia is a behavioral condition characterized by the intense desire to write. Forms of hypergraphia can vary in writing style and content. It is a symptom associated with temporal lobe changes in epilepsy, which is the cause of the Geschwind syndrome, a mental disorder. Possible structures that may have an effect on hypergraphia when damaged due to temporal lobe epilepsy are the hippocampus and Wernicke's area. Aside from temporal lobe epilepsy, chemical causes may also be responsible for inducing hypergraphia.

Hypergraphia has been popularly related to many cases of well-known individuals and artists who have this symptom.

Characteristics

Waxman and Geschwind were the first to describe hypergraphia. In the patients they observed, they displayed extensively compulsive detailed writing, sometimes with literary creativity. The patients kept diaries, which some used to meticulously document minute details of their everyday activities, write poetry, or create lists. Case 1 of their study wrote lists of her relatives, her likes and dislikes, and the furniture in her apartment. Besides lists, the patient also wrote poetry, often with a moral or philosophical undertone. She described an incident in which she wrote the lyrics of a song she learned when she was 17 several hundred times and also another incident in which she felt the urge to write a word over and over again. Another patient wrote aphorisms and certain sentences in repetition.

A patient from a separate study experienced "continuously rhyming in his head" for five years after a seizure and said that he "felt the need to write them down." The patient did not talk in rhyme, nor did he read poetry. Language capacity and mental status were normal for this patient, except for recorded right temporal spikes on electroencephalograms. This patient had right hemisphere epilepsy. Functional MRI scans of other studies suggest that rhyming behavior is produced in the left hemisphere, but Mendez proposed that hyperactive electrical activity of the right hemisphere may induce a release of writing and rhyming abilities in the left hemisphere.

Flaherty defines hypergraphia as a result of temporal lobe epilepsy as a condition that "increase[s] idea generation, sometimes at the expense of quality."

Causes

Macro and micrographic writing by the same epileptic

Some studies have suggested that hypergraphia is related to bipolar disorder, hypomania, and schizophrenia. Although creative ability was observed in the patients of these studies, it is important to note that signs of creativity were observed, not hypergraphia specifically. Therefore, it is difficult to say with absolute certainty that hypergraphia is a symptom of these psychiatric illnesses because creativity in patients with bipolar disorder, hypomania, or schizophrenia may manifest into something aside from writing. However, other studies have shown that there is a significant association between hypergraphia and temporal lobe epilepsy and chemical causes.

Temporal Lobe Epilepsy

Hypergraphia is known to be a symptom of temporal lobe epilepsy, a condition of reoccurring seizures caused by excessive neuronal activty, but it is not a common symptom among temporal lobe epilepsy patients. Less than 10 percent of patients who suffer from temporal lobe epilepsy exhibit characteristics of hypergraphia. In temporal lobe epilepsy patients, they may exhibit irritability, discomfort, or an increasing feeling of dread if their writing activity is disrupted. To illicit such responses when interrupting their writing suggests that hypergraphia is a compulsive condition, resulting in an obsessive motivation to write. A temporal lobe epilepsy may influence frontotemporal connections in such a way that the drive to write is increased in the frontal lobe, beginning with the prefrontal and premotor cortex planning out what to write, and then leading to the motor cortex (located next to the central fissure) executing the physical movement of writing.

Most temporal lobe epilepsy patients who suffer from hypergraphia can write words, but not all may have the capacity to write complete sentences that have meaning.

Pathophysiology

Several different regions of the brain are involved in the act of handwriting. Primary areas are the superior parietal cortex and the frontal lobe, the region of the brain that plans out movement. An area of the frontal lobe that is especially active is Exner's area, located in the premotor cortex. The physical motion of the hand is controlled by the primary motor cortex, also located in the frontal lobe, and the right cerebellum. Writing creatively and generating ideas, on the other hand, is controlled by the limbic system, specifically involving the activity of the hippocampus, which is important in the retrieval of long-term memories. Words and ideas are cognized and understood by the temporal lobes, and these temporal lobes are connected to the limbic system. Since regions of the brain are widely connected, damage to one region may affect activity in others. Therefore, hypergraphia cannot be localized to a specific brain structure.