BACKGROUND: Previous studies suggest that responsiveness is impaired during complex partial seizures (CPS) and pseudoseizures (PS); however, to our knowledge, there has been no systematic comparison using both response and memory testing. OBJECTIVE: To compare CPS with PS using ictal cognitive assessment (ICA) of responsiveness and memory. PATIENTS AND METHODS: We used a nonautomated method of ICA by bedside observers, consisting of family members and staff, during video electroencephalographic monitoring to test responsiveness and memory during the ictal phase in 245 events. We assessed the adequacy of testing and compared the testing results in 31 patients during CPS and 13 patients during PS. RESULTS: The ictal presentation of a command was successful in 58% of the events. The ictal presentation of at least 2 memory items with testing for recall after orientation was adequate in 57% of events. Impaired responsiveness was shown during both CPS and PS. However, some response was detected during 48% of PS compared with 18% of CPS (P<.01). Memory items were recalled during 63% of PS but during only 4% of CPS (P<.001). The International Classification of Epileptic Seizures remained useful, but in 11 events (8%), distinguishing complex from simple partial seizures was difficult. Recall of various types of stimuli (aural-verbal vs visual-pictorial) during ICA did not correlate with the side or location of the seizure focus, but this may have been confounded by the rarity of any memory recall during CPS. CONCLUSIONS: Ictal cognitive assessment by bedside observers is practical and provides the interaction necessary for properly classifying seizures; ICA, especially memory, may help to distinguish CPS from PS.
BACKGROUND: Previous studies suggest that responsiveness is impaired during complex partial seizures (CPS) and pseudoseizures (PS); however, to our knowledge, there has been no systematic comparison using both response and memory testing. OBJECTIVE: To compare CPS with PS using ictal cognitive assessment (ICA) of responsiveness and memory. PATIENTS AND METHODS: We used a nonautomated method of ICA by bedside observers, consisting of family members and staff, during video electroencephalographic monitoring to test responsiveness and memory during the ictal phase in 245 events. We assessed the adequacy of testing and compared the testing results in 31 patients during CPS and 13 patients during PS. RESULTS: The ictal presentation of a command was successful in 58% of the events. The ictal presentation of at least 2 memory items with testing for recall after orientation was adequate in 57% of events. Impaired responsiveness was shown during both CPS and PS. However, some response was detected during 48% of PS compared with 18% of CPS (P<.01). Memory items were recalled during 63% of PS but during only 4% of CPS (P<.001). The International Classification of Epileptic Seizures remained useful, but in 11 events (8%), distinguishing complex from simple partial seizures was difficult. Recall of various types of stimuli (aural-verbal vs visual-pictorial) during ICA did not correlate with the side or location of the seizure focus, but this may have been confounded by the rarity of any memory recall during CPS. CONCLUSIONS: Ictal cognitive assessment by bedside observers is practical and provides the interaction necessary for properly classifying seizures; ICA, especially memory, may help to distinguish CPS from PS.
Authors: Li Yang; Irina Shklyar; Hyang Woon Lee; Celestine C Ezeani; Joseph Anaya; Samantha Balakirsky; Xiao Han; Sheila Enamandram; Clara Men; Joyce Y Cheng; Abigail Nunn; Tanya Mayer; Czestochowa Francois; Molly Albrecht; Alan L Hutchison; Ee-Lynn Yap; Kevin Ing; Gvantsa Didebulidze; Bo Xiao; Hamada Hamid; Pue Farooque; Kamil Detyniecki; Joseph T Giacino; Hal Blumenfeld Journal: Epilepsia Date: 2011-12-09 Impact factor: 5.864
Authors: William C Chen; Eric Y Chen; Rahiwa Z Gebre; Michelle R Johnson; Ningcheng Li; Petr Vitkovskiy; Hal Blumenfeld Journal: Epilepsy Behav Date: 2014-01 Impact factor: 2.937
Authors: Andrew Bauerschmidt; Nika Koshkelashvili; Celestine C Ezeani; Ji Yeoun Yoo; Yan Zhang; Louis N Manganas; Kailash Kapadia; Deanna Palenzuela; Christian C Schmidt; Regina Lief; Bridget T Kiely; Tenzin Choezom; Michael McClurkin; Andrew Shorten; Kamil Detyniecki; Lawrence J Hirsch; Joseph T Giacino; Hal Blumenfeld Journal: Epilepsy Behav Date: 2012-11-30 Impact factor: 2.937
Authors: Markus Reuber; Min Chen; Jenny Jamnadas-Khoda; Mark Broadhurst; Melanie Wall; Richard A Grünewald; Stephen J Howell; Matthias Koepp; Steve Parry; Sanjay Sisodiya; Matthew Walker; Dale Hesdorffer Journal: Neurology Date: 2016-07-06 Impact factor: 9.910
Authors: Alistair Wardrope; Jenny Jamnadas-Khoda; Mark Broadhurst; Richard A Grünewald; Timothy J Heaton; Stephen J Howell; Matthias Koepp; Steve W Parry; Sanjay Sisodiya; Matthew C Walker; Markus Reuber Journal: Neurol Clin Pract Date: 2020-04