epilepsy and disorders of consciousnessdownloads.hindawi.com/journals/bn/2011/646483.pdfbehavioural...

Behavioural Neurology 24 (2011) 1 1DOI 10.3233/BEN-2011-0323IOS Press

Editorial

Epilepsy and Disorders of Consciousness

Andrea Eugenio Cavannaa,b,∗

aDepartment of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UKbDepartment of Neuropsychiatry, Institute of Neurology andUCL, London, UK

This issue of Behavioural Neurology is devoted tothe investigation of the long recognised link betweenepilepsy and disturbances of consciousness. Interestin this topic has witnessed an unprecedented scientificrenaissance over the last few years, for two orders ofreasons. First, most types of epilepsy are characterisedby specific alterations in the level of general aware-ness and/or the subjective contents of consciousness,which are central aspects of patients’ ictal experiencesand can now be assessed and quantified with newlydeveloped psychometric tools. Second, the investiga-tion of what Hughlings-Jackson called the ‘occasional,sudden, rapid and local discharges of grey matter’ hasstarted to shed light on the brain mechanisms underly-ing pathophysiological states of altered consciousness,thanks to the development of sophisticated neurophysi-ological and neuroimaging techniques. The implemen-tation of combined electroencephalography and func-tional magnetic resonance imaging (EEG-fMRI) is justan example of this ongoing revolution. Therefore, thefact that this special issue is appearing in BehaviouralNeurology reflects the surge of interest from both neu-rologists and neuroscientists. In this issue, epilepsy ex-perts from around the world have contributed their in-sights by reviewing the latest developments in clinicaland experimental research on epilepsy and conscious-ness.

The first set of contributions focuses on the phe-nomenological analysis of ictal alterations of con-sciousness in patients with epilepsy (Johanson), whichis accompanied by specific behavioural (Mula) and cog-nitive (Krishnamoorthy) changes. The second groupof papers presents our current knowledge of the brainmechanisms underlying altered consciousness in bothfocal (Bagshaw) and generalized (Seri) seizures. The

∗Address for correspondence. E-mail: [email protected].

sudden alterations of consciousness caused by absenceseizures are of particular conceptual relevance, and arealso addressed from a theoretical perspective (Bayne).The following section deals with two emerging scientif-ic paradigms which hold promise in refining our under-standing of the neural bases of epilepsy-induced alter-ations of consciousness. These are the definition of the‘default mode network’ (Blumenfeld), which has beenshown to have a central role in neuropsychiatric condi-tions characterised by alterations of consciousness, andthe conceptual framework of the ‘global workspace the-ory of consciousness’ (Bartolomei), which provides auseful model for understandingboth normal and alteredconscious states. Finally, the papers by Bagary, Selaiand Reuber address specific issues related to epilepsyand consciousness in clinical practice, namely the re-cent applications of neurostimulation techniques, theimpact of seizure-induced alterations of consciousnesson the quality of life of patients, and consciousness innon-epileptic attack disorder.

The quality of this collective effort confirms thatthe study of epilepsy-induced alterations of conscious-ness is central to the discipline of behavioural neurol-ogy. This was already recognised over a century agoby the fathers of modern behavioural neurology. Toquote Hughlings-Jackson again, his 1888 article “On aparticular variety of epilepsy(‘intellectual aura’), onecase with symptoms of organic brain disease” proudlystated that “He who is faithfully analysing many differ-ent cases of epilepsy is doing far more than studyingepilepsy. The highest centres(‘organ of mind’), thoseconcerned in such fits, represents all, literally all, partsof the body sensorially and motorially, in most complexways, in most intricate combinations, etc. A carefulstudy of many varieties of epileptic fits is one way ofanalysing this kind of representation by the ‘organ ofmind’.” We believe that this journal’s special issue onepilepsy and consciousness has proved him true.

ISSN 0953-4180/11/$27.50 2011 – IOS Press and the authors. All rights reserved

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