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Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Testing for minimal consciousness in complex partial and generalized tonic-clonic seizures
Alison McPherson1, Leticia Rojas, Andrew Bauerschmidt
1Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520-8018, USA.
Epilepsia
|August 31, 2012
Summary
Patients with complex partial seizures (CPS) retain more awareness than those with generalized tonic-clonic seizures (GTCS). This suggests CPS consciousness impairment is closer to a minimally conscious state than a coma.
Area of Science:
- Neuroscience
- Epilepsy Research
- Clinical Neurology
Background:
- Impaired consciousness during epilepsy seizures significantly impacts patient quality of life.
- Both complex partial seizures (CPS) and generalized tonic-clonic seizures (GTCS) involve loss of consciousness, potentially affecting similar brain networks.
- Previous research suggests CPS may involve milder neurological impairment than GTCS, potentially preserving some basic responses.
Purpose of the Study:
- To rigorously test the hypothesis that complex partial seizures (CPS) preserve more behavioral responses than generalized tonic-clonic seizures (GTCS).
- To compare the level of impaired consciousness during CPS and GTCS using standardized behavioral assessments.
- To determine if consciousness impairment in CPS more closely resembles a minimally conscious state or coma.
Main Methods:
- Conducted prospective testing during video-electroencephalography (EEG) monitoring in patients experiencing CPS and GTCS.
- Administered a standardized battery assessing responses to questions, commands, ball grasping, and visual tracking.
- Analyzed behavioral responses during ictal and postictal periods via video review.
Main Results:
- During both CPS and GTCS, patients could not respond to questions or commands.
- Patients with CPS frequently retained minimally conscious responses, such as ball grasping (60%) and visual tracking (58%).
- In contrast, patients with GTCS showed significantly lower rates of preserved ball grasping (10%) and visual tracking (11%).
Conclusions:
- Consciousness impairment during CPS is characterized by preserved basic behavioral responses, distinguishing it from GTCS.
- Findings suggest that impaired consciousness in CPS is more akin to a minimally conscious state than a coma.
- Further research into the neural networks underlying preserved functions in CPS could lead to improved treatment strategies for impaired consciousness in epilepsy.
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