Painful generalised clonic and tonic-clonic seizures with retained consciousness

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 63; no. 6; pp. 792 - 795
• Main Authors: Bell, William L, Walczak, Thaddeus S, Shin, Cheolsu, Radtke, Rodney A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.12.1997; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Adult; Astrocytoma - pathology; Astrocytoma - surgery; Astrocytoma - therapy; Biological and medical sciences; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Brain Neoplasms - therapy; Consciousness; Convulsions & seizures; Electroencephalography; epilepsy; Epilepsy, Generalized - complications; Epilepsy, Generalized - diagnosis; Epilepsy, Tonic-Clonic - complications; Epilepsy, Tonic-Clonic - diagnosis; Frontal Lobe - pathology; Frontal Lobe - surgery; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Pain; Pain - etiology; Parietal Lobe - pathology; Parietal Lobe - surgery; Patients; Short Report; Videotape Recording; Human; Nervous system diseases; Consciousness; Epilepsy; Grand mal; Exploration; Electroencephalography; Cerebral disorder; Case study; Electrodiagnosis; Symptomatology; Pain; Central nervous system disease
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.63.6.792

Two patients in whom consciousness and memory were retained during bilateral clonic or tonic-clonic seizures are reported on, and three patients reported on previously are reviewed. Ictal semiology differed from myoclonic and supplementary motor seizures, which are other seizure types characterised by bilateral motor movements and retained awareness. In the two new patients ictal pain was a prominent feature. It is proposed that propagation of seizure activity may be confined to the sensorimotor areas bilaterally while sparing the neural structures involved in maintaining consciousness and in processing language and memory. This unusual type of seizure may be misdiagnosed as a pseudoseizure. Detailed description of the ictal events and further laboratory evaluation including video-EEG monitoring may be necessary to make the distinction.