1
(E)A-3 H. Blumenfeld, et al. Neurology 2004
Behavior During Temporal Lobe Seizures
Descriptions below were based on review of videotapes of behavior during seizures for the patients in this study. Behaviors were described and rated by one reviewer and then reviewed and confirmed by a second independent reviewer. Reviewers were provided with seizure onset and end times based on intracranial EEG, but were otherwise blinded to the EEG data.
Behavioral rating was by a simple two tier classification modified from (1) as described previously (2): Seizures with impaired responsiveness to verbal questions or commands or with amnesia were rated as complex partial (CP). Seizures with normal responsiveness throughout were rated as simple partial (SP). Seizures in which staff or family members did not interact with the patient at any time during the seizure could not be rated (N/A).
Patient 1 (Onset side = Right temporal lobe)
Seizure 1: Onset time 19:40:49; End time 19:42:22 Rating: N/A
Seizure onset at 19:40:49 from sleep; eyes open looking ahead 40:49; 40:59 moving R arm; begins rubbing stomach and moving R leg at 41:05; looks to L at 41:11; picking at blankets from 41:23-41:35; 41:43 reaches for drink with R arm and takes a sip; 41.56 responds verbally to father (?appropriate? cannot understand what she's saying but she is interacting with her father); 42:15 nods, wiping mouth; 42:34 following commands to sit up.
Seizure 2: Onset time 21:16:36; End time 21:18:09 Rating: CP
Seizure onset (patient is getting into bed from being in bathroom) ; 16:43-51 picking at sheets with R arm, moving legs bilaterally; 16:51-17:36 picking at sheets with R arm and moving R leg; 21:16:36 Patient asks father "what are you doing?"; 16:58 father responds "are you having another seizure?" and patient gives no response to father's questions at 17:05, 17:11, 17:22, 17:33, 17:39; 17:43 patient makes eye contact with father; 17:49 patient begins to respond; staff enters at 18:25; 18:59 asked to squeeze hands B with no response; 19:03 holds hands up and steady on command; 19:11 asked if okay and responds "yes."
Seizure 3: Onset time 22:24:26; End time 22:25:52 Rating: SP
22:24:26 patient is awake at onset; 24:45 moving R arm and leg with lip smacking and blinking; 25:03 rubbing belly with R arm; 25:11 moving R leg; 25:19 person enters room and patient asked if okay and nods and makes eye contact; 25:28 patient states "I'm fine" and person responds that they're worried about her; 25:37 patient states "what?"; 25:48 asked if knew it was coming and patient says "what?" and person says, the seizure, and patient responds "yes" and asked how responds "the feeling"; 26:52 staff member enters; 27:16 asked are you awake with no response and asked if still seizing and patient responds by shaking head no; 27:32 asked if alright and patient shakes head yes; 27:45 patient puts hands down at her side and moves R on command to put both hands down; 27:52 asked to put both hands down and patient follows the command (there is a delayed response to these commands).
References
1. Lee KH, Meador KJ, Park YD, et al. Pathophysiology of altered consciousness during seizures: Subtraction SPECT study. Neurology 2002;59:841-846.
2. Blumenfeld H, McNally KA, Vanderhill SD, et al. Positive and negative network correlations in temporal lobe epilepsy. Cerebral Cortex 2004 14(8).
Patient 2 (Onset side = Left temporal lobe)
Seizure 1: Onset time 17:37:14; End time: 17:39:52 Rating: N/A
Patient asleep at onset; 17:37:27 patient moving (writhing motion with R hand, still has eyes closed; 37:53 patient gasps and lifts head and begins moving L UE and LE, still has eyes closed; 38:33 patient is picking at sheets with L hand ; 38:40 moves pillow with L arm; 38:52 reaches for piece of clothing with R arm, also using L arm; 29:31 lifting piece of clothing with both arms and picking at it ; 38:47 sits up in bed and rubs face (39:00); 40:13 still moving piece of clothing around without purpose; 40:41 reaches for another pillow and lies down on his side; 41:02 rubbing face and scanning room with eyes; 41:56 fold arms across chest (there was never any interaction with another person during this seizure).
Seizure 2: Onset time 7:35:04; End time: 7:37:45 Rating: N/A
Patient asleep and snoring at onset; 07:35:04. At 07:35:42 takes a deep breath and opens eyes; 36:11 moves L UE and begins picking at object on the bed; 37:06 moves object on the bed without purpose; 37:37 rubbing face; 37:42 turns head to the L; 38:16 crosses arms across chest; 38:32 moving pillow and blankets while lying on his side; 39:19 looks to the L (there's a noise coming from the hallway); tape ends and there was never any interaction with another person during this seizure.
Seizure 3: Onset time 15:19:02; End time: 15:21:28 Rating: CP
Seizure onset at 15:19:02 with patient sleeping; eyes open 19:10; 19:13 moving R UE and staring straight ahead; 19:51 picking at blankets; 20:02 head turns to R and patient holding bedrail with R UE; 20:22 "John" and no response; asked to lie down with no response; 20:30 remember "red rubber ball" and no response; 20:42 told to relax with no response by patient; 20:58 "can you talk to me?" responds "yes, what's up", asked if he feels he's seizing and he says "yes", asked if he remembers caregiver's name and he doesn't response; 21:18 squeezes hands on command but does not pull in against resistance on command; 21:27 holds arms up on command; 22:20 how are you doing? "fine", patient asks "what are you doing" and caregiver responds that they're injecting him (for SPECT), told that he had a seizure and he responds "just now?"
Patient 3 (Onset side = Left temporal lobe)
Seizure 1: Onset time 13:54:13; End time: 13:55:52 Rating: CP
Patient turned way from camera at onset seemingly asleep; 13:54:50 moves R leg; 54:56 lifts head; 55:06 asked what are you doing and patient responds "jumbled speech" while turning around and half sitting up in the direction of the caregiver; 55:17 asked what happened and says "I don't know" asked if okay and says "yeah"; 55:21 asked to lay down and responds "all right" but does not lay down; 55:32 asked to lean forward, which she doesn't; 55:53 lays down; 56:00 asked how she's doing and doesn't respond and asked to look at the caregiver and caregiver says that eyes are deviating to the L (caregiver is standing on the R); 56:16 asked to squeeze hand B and push legs and she follows commands and has "no strength problems" according to the caregiver; 56:12 asked how she's feeling and she said "okay"' 56:36 asked to sit up and she follows command; 56:49 follows command to lay down and begins speaking with the caregivers.
Seizure 2: Onset time 18:30:19; End time: 18:31:45 Rating: CP
Patient sleeping at onset; 18:30:40 moves head; 30:45 vocalizes; 30:48 asked what's the matter twice and has no response (still making moaning vocalizations); 30:52 and 30:57person in room yells patient's name twice and patient does not respond physically or verbally to the yelling; 31:07 asked to say caregiver's name and patient does not look towards person speaking or make any verbal response; eyes deviating to L; 31:37 asked question with no response; 31:45 not following command to squeeze hands; 31:33 not following command to follow finger with eyes; 32:11 still not answering questions; 32:28 does not squeeze fingers on command; 32:38 squeezes fingers on command ("not very strong"); 32:42 makes vocalization directed to caregiver; 32:48 unable to say caregiver's name when asked; 33:05 squeezes R hand on command, and moves feet on command, unable to wiggle toes on command; 33:24 do you know where you are? patient just grunts (unoriented); 33:56 asked if tired and she doesn't respond but making eye contact; 34:13 able to make eye contact but not answering question re: caregiver's name.
Seizure 3: Onset time 0:39:58; End time: 0:41:38 Rating: CP
Sleeping at seizure onset; 0:40:17 opens eyes and reaches to the L making grunting vocalizations; 40:22 caregiver enters ; 40:30 patient not responding to voice (her name); 40:46 asked if knows caregivers name and no response; 41:00 no response to voice, not making eye contact; 41:48 makes eye contact to voice of caregiver; 41:53 moves hands when asked to squeeze; 42:04 squeezes L hand when asked to squeeze bilaterally; 42:24 told she just had a seizure and she makes eye contact but no verbal response; 42:30 asked how her head is doing and she does not respond; 42:45 asked do you know who I am? and says "no" and then states "I just want to lay back down", which is an appropriate sentence.
Patient 4 (Onset side = Left temporal lobe)
Seizure 1: Onset time 23:23:03; End time: 23:28:45 Rating: CP
Watching TV at seizure onset; 23:23:20 begins blinking at regular intervals (every 1-2s) 23:39 reaches without purpose with R arm and caregiver holds arm with no response by patient (does not look at caregiver or verbalize); 24:00 making movements with mouth and not looking at caregiver; 24:27 not interacting or responding to voices in the environment; 24:40 until 55 not responding to name verbally or with eye contact; 24:56 does not squeeze hand on command; 25:08 not responding to name; 25:57 makes eye contact with caregiver when says her name and begins interacting; 26:08 says "yeah" when asked if alright; 26:16 squeezes R hand on command; 26:25 squeezes hands bilaterally on command; 26:39 unable to say his name when asked but making eye contact with caregiver; 27:37 does not lift L arm on command; remains minimally responsive to environment with ?eye contact for remainder of the tape (tape ends 30:19).
Seizure 2: Onset time 12:53:12; End time: 12:56:59 Rating: CP
Patient lying in bed with eye blinking and TV on at seizure onset;12:53:50 patient turns head to the L; 54:04 patient shifting about in bed; 54:12 caregiver enters room and patient is facing that way but does not appear to be interacting with environment; 54:44 patient is not following with eyes the caregivers as they move about the room; 54:53 asked to remember red rubber ball with no response by the patient; 55:03 patient asked how he's doing with no response; 55:08 asked to squeeze hand and patient follows command bilaterally; 55:15 asked where he is and does not respond and not making eye contact; 55: 30 asked what the year is and does not respond but makes eye contact; 55:52 does not pick up hands on command; 56:00 does not close eyes on command; 56:28 able to hold out arms when caregiver places them outright; 56:42 making eye contact but unable to verbalize (cant say hi or cat); 57:14 does not respond to questions and no longer making eye contact; 57:58 says "yeah" when asked if okay but unable to say where he is or recall what was asked earlier; he is continuing to stare with blinking until tape ends 58:40.
Seizure 3: Onset time 23:16:12; End time: 23:18:49 Rating: CP
Watching TV at seizure onset; 23:16:14 reaches with R arm (non-purposeful); 16:30 shifting in bed; 16:33 responds "what" when caregiver says the doctor's name (calling him into the room); 16:45 not responding to caregivers voice verbally or with eye contact; 17:00 squeezes hand bilaterally on command; 17:10 asked if he can say where he is and he seems to make eye contact and then mutters and tries to talk but cannot for next 20s; 17:40 raises R arm on command; 17:52 does not respond or make eye contact when asked how he feels; 18:15 able to follow commands to move feet and toes; 18:28 says "um" when asked where he is; 18:44 unable to say the year; 19:06 able to smile and stick out tongue on command; 19:15 able to say "red rubber ball" and begins interacting with observer verbally and following multiple commands.
Patient 5 (Onset side = Left temporal lobe)
Seizure 1: Onset time 10:37:08; End time: 10:39:16 Rating: CP
Patient's eyes are covered with a cloth at seizure onset and she is lying still; 10:38:00 patient is asked if she's alright and she doesn't respond; 10:38:15 cover removed from eyes, patient appears to be making eye contact (?) but eyes may just be roaming about room; 10:38:28 patient is verbalizing grunts; 10:38:37 people talking to patient and she is not orienting towards them and continues to verbalize grunts/screams; 10:38: 58 patient is screaming "no" over and over and says "no" in calmer voice at 10:39:05 and after that calms down; 10:39:33 asked to close eyes and she says "why";10:29:55 following commands and communicating with caregiver; 10:40:14 follows another command; 10:40:50 correctly identifies pen; 10:40:58 asked where she is and doesn't respond.
Patient 6 (Onset side = Right temporal lobe)
Seizure 1: Onset time 19:15:02; End time: 19:16:39 Rating: SP
Watching Jeopardy at seizure onset; 19:15:40 arms extend in clasped position; patient remains focused on TV; answers question on TV Jeopardy at 19:16:00; 19:16:30 caregiver enters and patient makes eye contact with her. She says hi and he responds "hi" and interacts with her until seizure ends; 16:55 asked where and who he is and he says Yale New Haven Hospital and is able to say his name.
Seizure 2: Onset time 13:05:20; End time: 13:06:58 Rating: CP
13:06:00 patient is watching TV at seizure onset; 06:14 caregiver comes in and says patient's name and he says "what" and he asks "will you hand me my other bottle?"; 06:36 asked to recall red rubber ball; 06:53 grasps bottle (urinal); 07:00 able to say YNHH, year, and identify pen, watch eye; 07:19 unable to recall red rubber ball; 07:41 able to close eyes and hold hands up and squeeze hands on command; 08:07 asked if knows what just happened and he says no and the caregivers say that he had a seizure and he says "that's good."