Level and contents of consciousness in connection with partial epileptic seizures

The present study introduces concepts and methods that can be used in the systematic psychological study of a seizure, to gain more insight into the seizure as it is experienced by the patient and the significant other. Fourteen patients reported 40 descriptions of their subjective experiences during complex partial seizures. We analyzed the descriptions with respect to the temporal progression of the seizure and the level and contents of consciousness. There were three main findings: (1) We identified an impairment of the voluntary control of attention ("forced attention") that seems to characterize the early stages of the seizure in all patients. (2) Although most patients reported the total absence of consciousness, we identified a subgroup of patients with a fluctuating level of consciousness during the seizure. (3) The patients who reported some contents of consciousness during the seizure were found to usually experience internal mental images rather than other contents of consciousness (e.g., sensations or perceptions). We propose that use of a qualitative methodology for the psychological assessment of seizures could lead to a better understanding of seizures as experienced from the patient's perspective and thereby to improvements in the treatment of seizures. (C) 2003 Elsevier Science (USA). All rights reserved.