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evokes feelings of pleasure and lust Also, Gorman and Cummings have described two patients who became sexually disinhibited after a shunt catheter had perforated the dorsal septal region This is in keeping with the experience of Heath and Fitzjarrell, who found that infusion of acetylcholine into the septal region (an experimental treatment for Parkinson disease) produced euphoria and orgasm, and with Heath s recordings from the septum of patients during sexual intercourse, showing greatly increased activity with spikes and slow waves Perhaps these are examples of a true overdrive of libido, as contrasted with simple disinhibition of sexual behavior However, we know of no case in which a stable lesion that caused abnormal sexual behavior has been studied carefully by sections of the critical parts of the brain In clinical practice, the commonest cause of disinhibited sexual behavior, next to the aftermaths of head injury and cerebral hemorrhage, is the use of dopaminergic drugs in Parkinson disease Mania may do the same Hyposexuality, meaning loss of libido, is most often due to a depressive illness However, certain medications notably antihypertensive, anticonvulsant, serotoninergic antidepressant, and neuroleptic drugs may be responsible in individual patients A variety of cerebral diseases may also have this effect, in parallel with a loss of interest and drive in a number of spheres Lesions that involve the tuberoinfundibular region of the hypothalamus are known to cause speci c disturbances in sexual function If such lesions are acquired early in life, pubertal changes are prevented from occurring; or, hamartomas of the hypothalamus, as in von Recklinghausen neuro bromatosis and tuberous sclerosis, may cause sexual precocity Autonomic neuropathies and lesions involving the sacral parts of the parasympathetic system, the commonest being prostatectomy, may abolish normal sexual performance but do not alter libido or orgasm Blumer and Walker have reviewed the literature on the association of epilepsy and abnormal sexual behavior They note that sexual arousal as an ictal phenomenon is apt to occur in relation to temporal lobe seizures, particularly when the discharging focus is in the mediotemporal region These authors also cite the high incidence of global hyposexuality in patients with temporal lobe epilepsy Temporal lobectomy in such patients has sometimes been followed by a period of hypersexuality.

(c) Can you make this algorithm deterministic (Hint: Instead of ipping a coin for each variable, select the value that satis es the most of the as of yet unsatis ed clauses What fraction of the clauses is satis ed in the end ) 99 In the MAXIMUM CUT problem we are given an undirected graph G = (V, E) with a weight w(e) on each edge, and we wish to separate the vertices into two sets S and V S so that the total weight of the edges between the two sets is as large as possible For each S V de ne w(S) to be the sum of all w(e) over all edges {u, v} such that |S {u, v}| = 1 Obviously, MAX CUT is about maximizing w(S) over all subsets of V Consider the following local search algorithm for MAX

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The phenomenon of acute fear and anxiety occurring as a prelude to or part of a seizure is familiar to every physician Williams s study, already mentioned, is of particular interest; from a series of about 2000 epileptics, he was able to cull 100 patients in whom an emotional experience was part of the seizure Of the latter, 61 experienced feelings of fear and anxiety and 21 experienced depression Daly has made similar observations These clinical data call to mind the effects that had been noted by Pen eld and Jasper when they stimulated the upper, anterior, and inferior parts of the temporal lobe and cingulate gyrus during surgical procedures; frequently the patient described feelings of strangeness, uneasiness, and fear In most instances, consciousness was variably impaired at the same time, and some patients had hallucinatory experiences as well In these cortical stimulations, neuronal circuits subserving fear are coextensive with those of anger; both are thought to lie in the medial part of the temporal lobe and amygdala, as discussed earlier Both in animals and in humans, electrical stimulation in this region

The normal pattern of sexual behavior in both males and females may be altered by cerebral disease quite apart from impairment due to obvious physical disability or to diseases that destroy or isolate the segmental re ex mechanisms (see Chap 26) Hypersexuality in men or women is a rare but well-documented complication of neurologic disease It has long been believed that lesions of the orbital frontal lobes may remove moralethical restraints and lead to indiscriminate sexual behavior, and that superior frontal lesions may be associated with a general loss of initiative that reduces all impulsivity, including sexual In rare cases, extreme hypersexuality marks the onset of encephalitis or develops gradually with tumors of the temporal region Possibly the limbic parts of the brain are disinhibited, the ones from which MacLean and Ploog could evoke penile erection and orgasm by electrical stimulation (medial dorsal thalamus, medial forebrain bundle, and septal preoptic region) In humans, Heath has observed that stimulation of the ventroseptal area (through depth electrodes)

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