title: Focal seizures without awareness.
abstract: OBJECTIVE
  To characterize patients with seizures that only occur without their awareness (SWA).
  
  
  METHODS
  Twenty-four patients with SWA were retrospectively identified by chart review and subsequently underwent video-EEG monitoring (VEM). Eleven patients met selection criteria for SWA and were never aware of any seizures. A case-matched control group of patients who were always aware (SA) was used for comparison. Statistical analysis included Pearson's Chi-square, Fisher's Exact, and Mann-Whitney.
  
  
  RESULTS
  Patients with SWA were older at seizure diagnosis than those with SA (p=0.04), were less often referred for evaluation of seizures or epilepsy (p=0.04), and were referred faster for VEM, despite SWA were significantly less likely to include motor manifestations (p=0.0004). SWA more often had temporal lobe onsets (p<0.0001) with left lateralization on ictal EEG (p<0.0001). At final follow up, patients with SWA had tried fewer antiseizure drugs (p=0.03), but reported seizure freedom as often as patients with SA (p=0.4).
  
  
  CONCLUSIONS
  We suggest that patients with SWA have a unique epilepsy syndrome. Patients with absent recall were older, referred later, had fewer motor signs, and dominant hemisphere limbic localization than patients with SA, but fewer antiseizure drugs are used in treatment. Patients with SWA can be detected from the clinical history, though serial VEM is needed to validate effective management.
authors.affiliation: University of Miami College of Medicine, Miami, Florida, USA. Electronic address: langston.ml@gmail.com.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Langston
authors.affiliation: Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida, USA. Electronic address: tatum.william@mayo.edu.
authors.forename: William O
authors.initials: WO
authors.lastname: Tatum
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D001364:Awareness; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D014741:Video Recording; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Antiseizure drug trial; Cognitive decline; Seizure awareness; Temporal lobe; Video-EEG