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Impaired consciousness in partial seizures is bimodally distributed

OBJECTIVE:: To investigate whether impaired consciousness in partial seizures can usually be attributed to specific deficits in the content of consciousness or to a more general decrease in the overall level of consciousness. METHODS:: Prospective testing during partial seizures was performed in pat... Full description

Journal Title: Neurology 2014, Vol.82(19), pp.1736-1744
Main Author: Cunningham, C., Courtney
Other Authors: Chen, P., William , Shorten, T., Andrew , Mcclurkin, T., Michael , Choezom, T., Tenzin , Schmidt, T., Christian , Chu, T., Victoria , Bozik, T., Anne , Best, T., Cameron , Chapman, T., Melissa , Furman, T., Moran , Detyniecki, T., Kamil , Giacino, T., Joseph , Blumenfeld, T., Hal
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ID: ISSN: 0028-3878 ; DOI: 10.1212/WNL.0000000000000404
Link: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00006114-201405130-00014
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title: Impaired consciousness in partial seizures is bimodally distributed
format: Article
creator:
  • Cunningham, C., Courtney
  • Chen, P., William
  • Shorten, T., Andrew
  • Mcclurkin, T., Michael
  • Choezom, T., Tenzin
  • Schmidt, T., Christian
  • Chu, T., Victoria
  • Bozik, T., Anne
  • Best, T., Cameron
  • Chapman, T., Melissa
  • Furman, T., Moran
  • Detyniecki, T., Kamil
  • Giacino, T., Joseph
  • Blumenfeld, T., Hal
subjects:
  • Coma
  • Consciousness
  • Cortex
  • Arousal
  • Cognitive Ability
  • Epilepsy
  • Seizures
  • Traumatic Brain Injury
  • Thalamus
  • Neurology & Neuropathology
ispartof: Neurology, 2014, Vol.82(19), pp.1736-1744
description: OBJECTIVE:: To investigate whether impaired consciousness in partial seizures can usually be attributed to specific deficits in the content of consciousness or to a more general decrease in the overall level of consciousness. METHODS:: Prospective testing during partial seizures was performed in patients with epilepsy using the Responsiveness in Epilepsy Scale (n = 83 partial seizures, 30 patients). Results were compared with responsiveness scores in a cohort of patients with severe traumatic brain injury evaluated with the JFK Coma Recovery Scale–Revised (n = 552 test administrations, 184 patients). RESULTS:: Standardized testing during partial seizures reveals a bimodal scoring distribution, such that most patients were either fully impaired or relatively spared in their ability to respond on multiple cognitive tests. Seizures with impaired performance on initial test items remained consistently impaired on subsequent items, while other seizures showed spared performance throughout. In the comparison group, we found that scores of patients with brain injury were more evenly distributed across the full range in severity of impairment. CONCLUSIONS:: Partial seizures can often be cleanly separated into those with vs without overall impaired responsiveness. Results from similar testing in a comparison group of patients with brain injury suggest that the bimodal nature of Responsiveness in Epilepsy Scale scores is not a result of scale bias but may be a finding unique to partial seizures. These findings support a model in which seizures either propagate or do not propagate to key structures that regulate overall arousal and thalamocortical function. Future investigations are needed to relate these behavioral findings to the physiology underlying impaired consciousness in partial seizures.
language:
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identifier: ISSN: 0028-3878 ; DOI: 10.1212/WNL.0000000000000404
fulltext: fulltext
issn:
  • 0028-3878
  • 00283878
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titleImpaired consciousness in partial seizures is bimodally distributed
creatorCunningham, C., Courtney ; Chen, P., William ; Shorten, T., Andrew ; Mcclurkin, T., Michael ; Choezom, T., Tenzin ; Schmidt, T., Christian ; Chu, T., Victoria ; Bozik, T., Anne ; Best, T., Cameron ; Chapman, T., Melissa ; Furman, T., Moran ; Detyniecki, T., Kamil ; Giacino, T., Joseph ; Blumenfeld, T., Hal
ispartofNeurology, 2014, Vol.82(19), pp.1736-1744
identifierISSN: 0028-3878 ; DOI: 10.1212/WNL.0000000000000404
descriptionOBJECTIVE:: To investigate whether impaired consciousness in partial seizures can usually be attributed to specific deficits in the content of consciousness or to a more general decrease in the overall level of consciousness. METHODS:: Prospective testing during partial seizures was performed in patients with epilepsy using the Responsiveness in Epilepsy Scale (n = 83 partial seizures, 30 patients). Results were compared with responsiveness scores in a cohort of patients with severe traumatic brain injury evaluated with the JFK Coma Recovery Scale–Revised (n = 552 test administrations, 184 patients). RESULTS:: Standardized testing during partial seizures reveals a bimodal scoring distribution, such that most patients were either fully impaired or relatively spared in their ability to respond on multiple cognitive tests. Seizures with impaired performance on initial test items remained consistently impaired on subsequent items, while other seizures showed spared performance throughout. In the comparison group, we found that scores of patients with brain injury were more evenly distributed across the full range in severity of impairment. CONCLUSIONS:: Partial seizures can often be cleanly separated into those with vs without overall impaired responsiveness. Results from similar testing in a comparison group of patients with brain injury suggest that the bimodal nature of Responsiveness in Epilepsy Scale scores is not a result of scale bias but may be a finding unique to partial seizures. These findings support a model in which seizures either propagate or do not propagate to key structures that regulate overall arousal and thalamocortical function. Future investigations are needed to relate these behavioral findings to the physiology underlying impaired consciousness in partial seizures.
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subjectComa ; Consciousness ; Cortex ; Arousal ; Cognitive Ability ; Epilepsy ; Seizures ; Traumatic Brain Injury ; Thalamus ; Neurology & Neuropathology;
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titleImpaired consciousness in partial seizures is bimodally distributed
descriptionOBJECTIVE:: To investigate whether impaired consciousness in partial seizures can usually be attributed to specific deficits in the content of consciousness or to a more general decrease in the overall level of consciousness. METHODS:: Prospective testing during partial seizures was performed in patients with epilepsy using the Responsiveness in Epilepsy Scale (n = 83 partial seizures, 30 patients). Results were compared with responsiveness scores in a cohort of patients with severe traumatic brain injury evaluated with the JFK Coma Recovery Scale–Revised (n = 552 test administrations, 184 patients). RESULTS:: Standardized testing during partial seizures reveals a bimodal scoring distribution, such that most patients were either fully impaired or relatively spared in their ability to respond on multiple cognitive tests. Seizures with impaired performance on initial test items remained consistently impaired on subsequent items, while other seizures showed spared performance throughout. In the comparison group, we found that scores of patients with brain injury were more evenly distributed across the full range in severity of impairment. CONCLUSIONS:: Partial seizures can often be cleanly separated into those with vs without overall impaired responsiveness. Results from similar testing in a comparison group of patients with brain injury suggest that the bimodal nature of Responsiveness in Epilepsy Scale scores is not a result of scale bias but may be a finding unique to partial seizures. These findings support a model in which seizures either propagate or do not propagate to key structures that regulate overall arousal and thalamocortical function. Future investigations are needed to relate these behavioral findings to the physiology underlying impaired consciousness in partial seizures.
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authorCunningham, C., Courtney ; Chen, P., William ; Shorten, T., Andrew ; Mcclurkin, T., Michael ; Choezom, T., Tenzin ; Schmidt, T., Christian ; Chu, T., Victoria ; Bozik, T., Anne ; Best, T., Cameron ; Chapman, T., Melissa ; Furman, T., Moran ; Detyniecki, T., Kamil ; Giacino, T., Joseph ; Blumenfeld, T., Hal
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abstractOBJECTIVE:: To investigate whether impaired consciousness in partial seizures can usually be attributed to specific deficits in the content of consciousness or to a more general decrease in the overall level of consciousness. METHODS:: Prospective testing during partial seizures was performed in patients with epilepsy using the Responsiveness in Epilepsy Scale (n = 83 partial seizures, 30 patients). Results were compared with responsiveness scores in a cohort of patients with severe traumatic brain injury evaluated with the JFK Coma Recovery Scale–Revised (n = 552 test administrations, 184 patients). RESULTS:: Standardized testing during partial seizures reveals a bimodal scoring distribution, such that most patients were either fully impaired or relatively spared in their ability to respond on multiple cognitive tests. Seizures with impaired performance on initial test items remained consistently impaired on subsequent items, while other seizures showed spared performance throughout. In the comparison group, we found that scores of patients with brain injury were more evenly distributed across the full range in severity of impairment. CONCLUSIONS:: Partial seizures can often be cleanly separated into those with vs without overall impaired responsiveness. Results from similar testing in a comparison group of patients with brain injury suggest that the bimodal nature of Responsiveness in Epilepsy Scale scores is not a result of scale bias but may be a finding unique to partial seizures. These findings support a model in which seizures either propagate or do not propagate to key structures that regulate overall arousal and thalamocortical function. Future investigations are needed to relate these behavioral findings to the physiology underlying impaired consciousness in partial seizures.
pub© 2014 American Academy of Neurology
doi10.1212/WNL.0000000000000404
eissn1526632X
date2014-05-13