What is Pinocchio Syndrome?
According to F Sellal the Pinocchio syndrome is a typical form of reflex epilepsies and can be defined as an epileptic seizures attack which recurrently aggravated by a particular sensory stimulus. The onset of the epileptic seizure attack is unexpected, such as during reading or decision making, but usually, arise in consequence of lying. F Sellal made this concept depending upon the bellow mentioned case study in 19931,2.
Pinocchio syndrome Case History
The following case history can aid to understand the clinical presentation of Pinocchio syndrome. A 51 years old patient had experienced 3 epileptic seizure attacks along with the loss of consciousness and generalized type of convulsions. Subsequently, he became confuse for a very short period of time (few minutes). Before this medical event, since five years, the patient had regularly experienced peculiar sensations several times in a day and continue for one to two weeks and same sensory stimulation also felt before the epileptic seizure attacks initiated.
The clinical presentation of sensory stimulation includes epigastric constriction, a feeling of hot flush expanding from his abdomen to his brain, and then aural and visual misapprehensions, for example, the impression of hearing in resonance or metamorphose, with extreme anxiety. It was expected patient had more than three attacks when he lied due to the business purpose. The episodes of other attacks aroused without providing any apparent triggering factor.
At the time of diagnosis, the following diagnostic characteristics were observed:
- An EEG explained a sluggish nature of right anterior and temporal region, but no supportive epileptogenic instance found.
- Images obtained from MRI confirmed presence of a 30 mm diameter of meningioma at the location of the right cavemous sinus wall and the anterior clinoid process, close to the sella turcica. It compacted the medial component of the right temporal lobe with a mass consequence.
The patient condition became improved by prescribing him carbamazepine therapy and subsequently addition of meningioma ablation and no reported further attacks.
Further detail description of the nature of the attacks has identified as partial vegetative seizures and the characteristic of the epilepsy is matched with reflex epilepsy.
It is assumed that regular emotional stress, which mainly develops after lying can act as a triggering factor that provokes the onset of a seizure. To illustrate this concept, It has been found that emotion has some correlation with the limbic lobe and stimulation of this lobe may enhance its firmness by the meningioma. If we consider the provided case study, the patient certainly underwent some emotional stress when he was lying and that stimulates limbic lobe, which acts as a triggering factor for epileptic discharge in the amygdala.
In Adventures of Pinocchio, the famous children story book written by Collodi, where lies made Pinocchio’s nose grow. Similarly the patient’s lies, in the mentioned case study, turned out to be evident for his interlocutors. Thanks to carbamazepine which made it possible for him to join his work again, and being a eurocrat by profession it is obvious for him to use lies to evoke the truth in negotiating for adversarial European Economic Committee1,2,3.
Different Approach Of Pinocchio syndrome
Department of Experimental Psychology from the University of Granada found another approach of Pinocchio syndrome. According to this novel approach, lie increases nose temperature. This study applies thermography in the field of psychology. According to this study findings, psychological influence can modify body temperature, which includes enhanced mental effort alter facial temperature.
Lying usually increase mental effort, as the false information or statement creation and deliverance need mental utilization and this also enhances the emotional state of psychology as it creates a panic situation. All this pathophysiological alteration causes increase temperature around the nose, which extends to orbital muscles present at the interior chamber of the eye.
A lie expression about our feelings increases the temperature around our nose due to deactivation of brain element termed as ‘insula’. The role of the insula is the identification and controlling of body temperature. Insula is only activated when our psychology receives genuine signal and that can only possible after experiencing real feelings or “qualias”.
Therefore, the insula is considered as an element of the brain reward system. It has been found that there is a reverse condition appears between temperature enhancement and insula activation, means insula activation leads to lowering of the body temperature and opposite effect occurs in reverse condition. During lovemaking, boys get excited similarly girls also become excited, but usually, girls usually denied this emotional state. But the facial temperature alteration can expose the reality by increasing the temperature around the nose and this condition is expressed as Pinocchio syndrome4.
- Sellal F, Chevalier Y, Collard M.; ‘Pinocchio syndrome’: a peculiar form of reflex epilepsy?; J Neurol Neurosurg Psychiatry. 1993 Aug;56(8):936; Online available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1015158/
- Beaumanoir A, Gastaut H, Naquet R. Reflex seizures and reflex epilepsies. Geneva: Editions Medicine et Hygiene, 1989:555.
- Gastaut H, Tassinari CA. Triggering mechanisms in epilepsy. The electroclinical point of view. Epilepsia 1966;7:85-138.
- University of Granada. “‘Pinocchio effect’ confirmed: When you lie, your nose temperature rises.” ScienceDaily. ScienceDaily, 3 December 2012. <www.sciencedaily.com/releases/2012/12/121203081834.htm>.Online available at https://www.sciencedaily.com/releases/2012/12/121203081834.htm