Subjective and objective characteristics of altered consciousness during epileptic seizures

CAMPORA NURIA; KOCHEN SILVIA

EPILEPSY & BEHAVIOR (PRINT)

ACADEMIC PRESS INC ELSEVIER SCIENCE

Lugar: Amsterdam; Año: 2016 vol. 55 p. 128 - 132

1525-5050

Background: Conscious states are inner states and processes of awareness. These states are by definitionsubjective.Methods: We analyzed subjective and objective characteristics of alteration of consciousness (AOC) during epilepticseizures, including its involvement in both the level of awareness and subjective content of consciousness.We evaluated AOC using the Consciousness Seizure Scale, the Ictal Consciousness Inventory, and a new structuredsurvey developed by our group: the Seizure Perception Survey, which incorporates patients´ subjective experiencesbefore and after they watch a video-electroencephalographic recording of their own seizure.Results: We included 35 patients (105 seizures) with drug-resistant epilepsy. Most seizures caused profoundAOC. The content of consciousnesswas lower during temporal seizureswith profound AOC. Weuncovered a correlationbetween the subjective perception and objective duration of a seizure using the Seizure Perception Surveyregarding memory; the patients had a better recall of ictal onset during wakefulness regardless of theepileptogenic zone, laterality, or magnitude of AOC. Nonetheless, the recovery of memory at the end of a seizuretook more time in patientswho showed greater AOC, less vivid content of consciousness, or a longer seizure. For85% of the patients, this was the first time they were able to view their own seizures. The majority of the patientsrequested to view them again because this procedure allowed them to compare the recordings with their ownmemories and emotions during a seizure and to verify the real duration of the seizure.Discussion: Alteration of consciousness is one of the most dramatic clinical manifestations of epilepsy. Usually,practitioners or relatives assume that the patients with AOC may not have any knowledge on their seizures. Inthis study, however, we found that most patients with AOC had a fairly accurate perception of the duration ofa seizure and retained their memory of ictal onset. In contrast, for the majority of the patients, watching theirown seizure was an extremely positive experience, and most patients stated that they were surprised as wellas glad to view what really happened, without expressing negative opinions. Inclusion of subjective characteristicsof AOC into the analysis yielded complete assessment of various dimensions of consciousness and thereforeallowed us to gain a more detailed understanding of consciousness.