Date of Award

2-23-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Susan Spencer

Abstract

We examined patients' seizure awareness as it relates to various seizure characteristics in order to define a subset of epilepsy patients at increased risk for not recognizing their seizures. This study consisted of a retrospective chart/video review component and prospective inpatient seizure monitoring component with patients' seizure awareness determined by video or direct patient report, respectively. Seizure awareness was related to seizure location, subtype, vigilance state, aura, etiology, neuropsychological scores, patients' self-reports of awareness, and seizure awareness as charted by the physician. The 37 patients in the retrospective component and 29 patients in the prospective component failed to recognize 39% and 44% of their seizures, respectively. We also revealed a number of seizure characteristics that significantly related to decreased seizure awareness (all p < 0.02). Temporal lobe seizures were more likely to go unrecognized (48-62%) than extratemporal (24-27%). As were left or dominant hemisphere seizures (55-59%) compared to right or nondominant hemisphere seizures (20-30%). Left or dominant temporal lobe seizures were much more likely to be unrecognized (66-77%) than right or nondominant (12-37%). Only CPS (63%) and GTC (46%) seizures went unrecognized, while SPS (0%) never did. Seizures during sleep were unrecognized (55-56%) more often than seizures during wake state (26-33%). Akin to the observation in seizures types, seizures without aura were unrecognized (54-64%) considerably more often than seizures with aura (3-7%). Seizures caused by infectious (78%) or traumatic (88%) etiology were more often unrecognized than idiopathic seizures (42%) or seizures caused by structural etiologies (4%). Our study also highlights the patients' and physicians' inabilities to determine a patients' seizure awareness level, with only 67% of patients and 47% of physicians correctly identifying the patients' seizure awareness level. Overall, we conclude that subsets of patients with any or all the of following characteristics are more likely to have decreased seizure awareness: temporal lobe seizures, left or dominant hemisphere seizures, left or dominant temporal lobe seizures, CPS or GTC seizures, seizures during sleep, seizures without aura, and seizures caused by infection or trauma. We hope that by using these characteristics physicians will be able to more accurately determine those patients who are at higher risk of having unrecognized seizures so that more intensive seizure monitoring can be provided as needed.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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