Testing Ictal Conscious Awareness: Responsiveness Versus Recall of Experiences During Seizures
Abstract number :
3.19
Submission category :
4. Clinical Epilepsy / 4A. Classification and Syndromes
Year :
2021
Submission ID :
1825694
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:50 AM
Authors :
Hal Blumenfeld, MD, PhD - Yale University School of Medicine; Violeta Contreras Ramirez, MS – Neurology, Yale University School of Medicine; Bogdan Patedakis Litvinov, MD – Neurology – Yale University School of Medicine; Aparna Vaddiparti, MD – Neurology – Yale University School of Medicine; Nisali Anuradha Gunawardane, MD – Neurology – Yale University School of Medicine; Courtney Yotter, MS – Neurology – Yale University School of Medicine; Imran Quraishi, MD, PhD – Neurology – Yale University School of Medicine; Hal Blumenfeld, MD, PhD – Neurology, Neuroscience, and Neurosurgery – Yale University School of Medicine
Rationale: Evaluating if conscious awareness is impaired during seizures is of critical importance for guiding clinical recommendations. The International League Against Epilepsy (ILAE) guidelines recommend relying on post-ictal recall of experiences during seizures and not on ictal responsiveness to assess for impaired or spared awareness. Using either method in isolation may have limitations. Relying only on post-ictal recall could be problematic if patients experience post-ictal amnesia, even if their ictal awareness is spared. Conversely, relying only on ictal responsiveness can also have limitations if patients are unable to respond due to motor arrest, in spite of being aware. Given the important implications that assessing awareness in seizures has for clinical practice, we decided to investigate which methods are used by clinicians.
Methods: We retrospectively reviewed intracranial video-electroencephalogram (EEG) of ten patients (35 seizures) with intractable temporal lobe epilepsy while they underwent monitoring at the Yale New Haven Hospital (YNHH) Epilepsy Monitoring Unit (EMU). We then categorized their clinical seizures as being tested for recall of experiences, responsiveness during the seizure, both, or neither. Additionally, we conducted an online survey to assess how clinical providers across various institutions assess for ictal awareness in their clinical practice.
Results: We discovered that at the YNHH EMU, clinicians used ictal responsiveness to assess for conscious awareness during seizures much more often than post-ictal recall of experiences (80% versus 34%, respectively). There was an overlap in 29% of seizures, in which both methods were used. However, the results of our survey with 58 respondents showed that clinicians report using both measures, response and recall, much more often than either measure alone (p < 0.05, chi-squared test). Interestingly, most clinicians also believe that the ILAE guidelines recommend using both measures to assess for awareness in epilepsy.
Clinical Epilepsy