Patient awareness of complex partial seizures.
OBJECTIVE
To assess self-awareness of complex partial seizures (CPSs) in unselected epilepsy patients through a thorough interview.


METHODS
The study comprised 134 patients at our epilepsy clinic, whose CPSs had been documented by the patient's family members. We investigated the proportion and characteristics of patients unaware of their CPSs compared to those who were, and we monitored the evolution of unawareness of CPSs during the follow-up.


RESULTS
Thirty-one (23%) patients were assigned to the unawareness group (complete, 23; incomplete, 8) and 103 (67%) patients to the awareness group. Patients in the unawareness group were older and had a later age of onset than patients in the awareness group. Interictal epileptiform discharges (IEDs) localized primarily to the temporal region and were more frequently detected in the unawareness group (94%) than the awareness group (55%). Bilateral independent IEDs were found more frequently in the unawareness group than in the awareness group (48% vs. 13%). The bilateral presence of lesions was also more frequent in the unawareness group than the awareness group (16.1% vs. 4.9%). Six (26%) of 23 patients with complete unawareness of their CPSs had experienced awareness of CPSs during the follow-up. Two of these patients even experienced the emergence of de novo aura.


CONCLUSIONS
Our results indicate that a significant number of epilepsy patients are not aware of their CPSs. Unawareness of CPSs may be related to bitemporal dysfunction and a rapid and complete loss of consciousness caused by rapid spread of ictal discharges to the contralateral hemisphere in association with bilateral independent IEDs and bilateral presence of lesions.
Heo
Kyoung
K
Department of Neurology, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea. kheo@yumc.yonsei.ac.kr
Han
Sang-Don
SD
Lim
Sung Ryoung
SR
Kim
Mi Ae
MA
Lee
Byung In
BI
D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000553:Ambulatory Care; D001364:Awareness; D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D017029:Epilepsy, Complex Partial / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006304:Health Status; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013702:Temporal Lobe / Q000503:physiopathology