Epileptic qualia and self-awareness: a third dimension for consciousness

Over the last few decades, there has been increasing awareness among epileptologists about the need to refine our understanding and assessment of ictal consciousness, focusing on both subjective and behavioral aspects of seizures. Specifically, there have been suggestions that both the internal and external milieux - the former related to the phenomenal qualia of experience, the latter related to behavior - must be taken into account for a better understanding of altered states of consciousness in epilepsy. It has been proposed that clinical and experimental data from patients experiencing alterations of consciousness during epileptic seizures could be better understood within a bidimensional model, in which any manifestation of conscious experience can be plotted according to the level and contents of consciousness. The 'level' axis measures the degree of alertness/arousal, whereas the 'contents' axis measures the vividness of specific experiential phenomena reported by the patient. We argue that certain seizure types might require more rigorous conceptual models for their characterization, and we highlight the potential usefulness of a more refined framework which includes a further dimension related to the 'self', in addition to those of 'level' and 'contents'. This model could be visualized in a three-dimensional space to allow fine-grained distinctions between epileptic seizures.