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Letters to the Editor
December 2001

Dual Brain Pathology in Patients With Affective Aggressive Episodes—Reply

Arch Gen Psychiatry. 2001;58(12):1187-1188. doi:

In reply

Tebartz van Elst and colleagues report a reduction in gray matter specifically in the left dorsolateral region of the prefrontal cortex in patients with epilepsy who have intermittent explosive disorder,1 and ask whether our finding of reduced prefrontal gray matter in antisocial personality disorder (APD) was lateralized to the left hemisphere. In response, it was not. As outlined in our original article, the group × hemisphere interaction for prefrontal gray matter volume was nonsignificant (F2,78 = 1.9; P = .16). Contrary to the work of Damasio,2 which suggests a deficit to the orbitofrontal region, the findings of Tebartz van Elst and colleagues on aggressive patients with epilepsy indicate that the deficit may be localized to the dorsolateral prefrontal cortex. We are currently working on a differential test of this prediction.