Premium
Impaired consciousness in epilepsy investigated by a prospective responsiveness in epilepsy scale (RES)
Author(s) -
Yang Li,
Shklyar Irina,
Lee Hyang Woon,
Ezeani Celestine C.,
Anaya Joseph,
Balakirsky Samantha,
Han Xiao,
Enamandram Sheila,
Men Clara,
Cheng Joyce Y.,
Nunn Abigail,
Mayer Tanya,
Francois Czestochowa,
Albrecht Molly,
Hutchison Alan L.,
Yap EeLynn,
Ing Kevin,
Didebulidze Gvantsa,
Xiao Bo,
Hamid Hamada,
Farooque Pue,
Detyniecki Kamil,
Giacino Joseph T.,
Blumenfeld Hal
Publication year - 2012
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2011.03341.x
Subject(s) - ictal , epilepsy , electroencephalography , psychology , unconsciousness , subclinical infection , audiology , medicine , neuroscience , psychiatry
Summary Purpose: Impaired consciousness in epileptic seizures has a major negative impact on patient quality of life. Prior work on epileptic unconsciousness has mainly used retrospective and nonstandardized methods. Our goal was to validate and to obtain initial data using a standardized prospective testing battery. Methods: The responsiveness in epilepsy scale (RES) was used on 52 patients during continuous video–electroencephalography (EEG) monitoring. RES begins with higher‐level questions and commands, and switches adaptively to more basic sensorimotor responses depending on patient performance. RES continues after seizures and includes postictal memory testing. Scoring was conducted based on video review. Key Findings: Testing on standardized seizure simulations yielded good intrarater and interrater reliability. We captured 59 seizures from 18 patients (35% of participants) during 1,420 h of RES monitoring. RES impairment was greatest during and after tonic–clonic seizures, less in partial seizures, and minimal in auras and subclinical seizures. In partial seizures, ictal RES impairment was significantly greater if EEG changes were present. Maximum RES impairment (lowest ictal score) was also significantly correlated with long postictal recovery time, and poor postictal memory. Significance: We found that prospective testing of responsiveness during seizures is feasible and reliable. RES impairment was related to EEG changes during seizures, as well as to postictal memory deficits and recovery time. With a larger patient sample it is hoped that this approach can identify brain networks underlying specific components of impaired consciousness in seizures. This may allow the development of improved treatments targeted at preventing dysfunction in these networks.