Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Hal Blumenfeld

Abstract

Evaluating if consciousness is impaired during seizures is of critical importance for guiding recommendations for people with epilepsy, such as whether it is safe for them to drive or operate machinery. The latest International League Against Epilepsy guidelines classify focal seizures based on awareness, defined as successful postictal recall of ictal experiences, and exclude the use of responsiveness during seizures for classification. One reason responsiveness was excluded is that it was thought to not be commonly tested during seizures. We assessed how often responsiveness and recall were each evaluated in a well-defined group of patients with mesial temporal lobe epilepsy undergoing intracranial EEG-video monitoring. We found that responsiveness during seizures was tested more frequently than recall of ictal events after seizures. Of 35 seizures in 10 patients, responsiveness was tested in 28 seizures, whereas recall was tested in only 12. Furthermore, we investigated how clinicians assess for awareness during focal seizures in their clinical practice, and how they understand the current ILAE guidelines via an anonymous online survey. We obtained data from 58 respondents at 11 medical institutions, consisting mainly of academic epilepsy practitioners. We found that most respondents use both responsiveness and recall to assess for awareness, with 78% using this combined approach in the clinic and 72% in the epilepsy monitoring unit. This result reflects their understanding of ILAE guidelines, as 60% of respondents believe that the ILAE recommends using both measures. Given the preference of clinicians to use both methods together, and the potential weaknesses of using either method alone, we believe that recall and responsiveness together would provide a more accurate and clinically useful classification of awareness in focal seizures.

Comments

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

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