I am assisting in medical case management of a patient and am trying to distinguish between neurological vs psychiatric etiology of a presenting "behavioral" problem. HISTORY: 34-year-old male with severe MR, complex partial seizures since childhood (now controlled with medication) severe explosive "behavioral" tantrums--spontaneous onset and resolution with no particular antecedents. Presentation looks more like some sort of neurologically-based "paroxysm" than a "behavioral" event. CT scan at age 1; none since due to poor tolerance of diagnostic tests. Old CT showed "cerebral calcifications probably to include the cerebral cortex anteriorly and..subependymal white matter posteriorly"; also, microcephaly. Etiology: r/o interuterine infection. Temporal lobe involvement suspected; in the differential, but can't diagnose for sure due to no recent CT or MRI. Seizures look like temporal lobe: present exclusively as purposeless repetitive movements of lips and hands. Rx: Lamictal 100mg BID and Trileptal 150mg am, 300mg pm for seizures. Increases in AEDs were tried to manage the paroxysm-like tantrums, but patient could not tolerate. Now taking Geodon 40mg BID for the tantrums - working fairly well. (the only antipsychotic that patient would tolerate.) Onset of seizures in childhood; onset of explosive behaviors five years ago. (Progressive neurodegeneration?) Patient's spontaneous "explosions" do not seem to be psychiatrically- or behaviorally-based. Possibly due more to neurological disorder (?). Could the following factors be contructed into a reasonable hypothetical model to give credence to the theory of primary neurological cause of intermittent explosiveness: congenital brain calcifications - scarring - further neurodegeneration over 33-years since original CT scan(?) - temporal lobe epilepsy - intermittent spontaneous onset/offset violent tantrum-like presentation (related to temporal lobe dysfunction?) Can you help to construct such a hypothetical model?