These authors contributed equally to this manuscript.
Testing for minimal consciousness in complex partial and generalized tonic–clonic seizures
Article first published online: 29 AUG 2012
Wiley Periodicals, Inc. © 2012 International League Against Epilepsy
Volume 53, Issue 10, pages e180–e183, October 2012
How to Cite
McPherson, A., Rojas, L., Bauerschmidt, A., Ezeani, C. C., Yang, L., Motelow, J. E., Farooque, P., Detyniecki, K., Giacino, J. T. and Blumenfeld, H. (2012), Testing for minimal consciousness in complex partial and generalized tonic–clonic seizures. Epilepsia, 53: e180–e183. doi: 10.1111/j.1528-1167.2012.03657.x
- Issue published online: 2 OCT 2012
- Article first published online: 29 AUG 2012
- Accepted July 25, 2012; Early View publication August 29, 2012.
- Complex partial seizures;
- Generalized tonic–clonic seizures;
- Visual tracking;
- Minimally conscious state;
- Vegetative state
Impaired consciousness in epilepsy has a major negative impact on quality of life. Prior work suggests that complex partial seizures (CPS) and generalized tonic–clonic seizures (GTCS), which both cause loss of consciousness, affect similar frontoparietal networks. Milder involvement in CPS than in GTCS may spare some simple behavioral responses, resembling the minimally conscious state. However, this difference in responses has not been rigorously tested previously. During video–electroencephalography (EEG) monitoring, we administered a standardized prospective testing battery including responses to questions and commands, as well as tests for reaching/grasping a ball and visual tracking in 27 CPS (in 14 patients) and 7 GTCS (in six patients). Behavioral results were analyzed in the ictal and postictal periods based on video review. During both CPS and GTCS, patients were unable to respond to questions or commands. However, during CPS, patients often retained minimally conscious ball grasping and visual tracking responses. Patients were able to successfully grasp a ball in 60% or to visually track in 58% of CPS, and could carry out both activities in 52% of CPS. In contrast, during GTCS, preserved ball grasp (10%), visual tracking (11%), or both (7%), were all significantly less than in CPS. Postictal ball grasping and visual tracking were also somewhat better following CPS than GTCS. These findings suggest that impaired consciousness in CPS is more similar to minimally conscious state than to coma. Further work may elucidate the specific brain networks underlying relatively spared functions in CPS, ultimately leading to improved treatments aimed at preventing impaired consciousness.