title: Impaired consciousness in epilepsy investigated by a prospective responsiveness in epilepsy scale (RES).
abstract: OBJECTIVE
  Impaired consciousness in epileptic seizures has a major negative impact on patient quality of life. Prior work on epileptic unconsciousness has mainly used retrospective and nonstandardized methods. Our goal was to validate and to obtain initial data using a standardized prospective testing battery.
  
  
  METHODS
  The responsiveness in epilepsy scale (RES) was used on 52 patients during continuous video-electroencephalography (EEG) monitoring. RES begins with higher-level questions and commands, and switches adaptively to more basic sensorimotor responses depending on patient performance. RES continues after seizures and includes postictal memory testing. Scoring was conducted based on video review.
  
  
  RESULTS
  Testing on standardized seizure simulations yielded good intrarater and interrater reliability. We captured 59 seizures from 18 patients (35% of participants) during 1,420 h of RES monitoring. RES impairment was greatest during and after tonic-clonic seizures, less in partial seizures, and minimal in auras and subclinical seizures. In partial seizures, ictal RES impairment was significantly greater if EEG changes were present. Maximum RES impairment (lowest ictal score) was also significantly correlated with long postictal recovery time, and poor postictal memory.
  
  
  CONCLUSIONS
  We found that prospective testing of responsiveness during seizures is feasible and reliable. RES impairment was related to EEG changes during seizures, as well as to postictal memory deficits and recovery time. With a larger patient sample it is hoped that this approach can identify brain networks underlying specific components of impaired consciousness in seizures. This may allow the development of improved treatments targeted at preventing dysfunction in these networks.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, CT 06520-8018, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
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authors.forename: Hyang Woon
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authors.forename: Celestine C
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authors.forename: Abigail
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authors.forename: Czestochowa
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authors.forename: Molly
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authors.forename: Bo
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authors.lastname: Hamid
authors.forename: Pue
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authors.initials: JT
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mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003244:Consciousness Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004568:Electrodiagnosis / Q000379:methods / Q000592:standards; D004569:Electroencephalography / Q000379:methods / Q000592:standards; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D014741:Video Recording / Q000379:methods / Q000592:standards; D055815:Young Adult