hypnagogue said:
I know you must've expounded on this topic a hundred times already on PF...
Actually, the subject I usually beat to death is
simple-partial seizures. The "simple" refers to the fact there is no loss of consciousness, or even defect of consciousness.
but if you're up to it I'd be open to learning about complex-partial seizures and discussing what can be concluded from them.
Complex partials are the next step up in severity of effect on consciousness. The person is not
unconscious, but usually in something like a sleepwalking state.
"Clearly, as the examples in this text show, these patients are not, in the ordinary sese of the word, unconscious. A patient under general anaesthesia is unconscious; however, a patient who, during a complex partial seizure, drives a car, clearly is not. In light of this, others have spoken of a `loss of contact' wherein the patient's behaviour no longer `fits' well with the environment, indicating that such a patient is out of touch.' Another proposed name for this defect of consciousness is `disturbance of contact.' However, this term seems too broad, as it could certainly include much of the symptomatology seen in illnesses such as schizophrenia. In light of this uncertainty in terminology, a return to historical roots seems prudent, and consequently in this text, Jackson's phrase `defect of consciousness' is used."
p.35
"It appears that bilateral temporal lobe involvement is required before the full symptomology of a complex partial seizure can appear. Although isolated aurae may occur secondary to seizure activity confined to one lobe, it appears that both temporal lobes must be involved before the defect of consciousness appears. Thus, when a complex partial seizure evolves out of an aura, it is generally an indication that seizure activity has spread from one temporal lobe to the contralateral temporal lobe."
p.90
Partial Seizures and Interictal Disorders
The Neuropsychiatric Elements
David P. Moore, M.D. 1997 Butterworth-Heinemann, Newton Mass. USA
A simple partial (aura) remains such so long as it is confined to one hemisphere. Once it spreads across the corpus callosum into the other hemishpere, consciousness becomes defective. As far as I know, this is accomplished simply by interrupting normal limbic, medial, and cortical functions, with no involvement of the thalamus.
This will probably not mean much until you read a good variety of case studies describing what people act like during complex partials. For the most part, they have amnesia for the whole thing after he fact, don't know what they did, and certainly can't explain what was going through their mind at the time.
Some people perseverate with whatever they were doing when the seizure started, others have a routine set of automatic behaviours. Most often you see some odd oral activity like lip smacking, chewing movements, mumbling noises, and such, which indicates involvement of the amygdala, (an organ somehow linked to oral activities, but I'm not sure how.) There is usually some residual responsiveness to the environment: a grunt of recognition at having their name called, but some people seem much more reponsive: as alert to the environment as, say, an extremely drunk person (but without the physical impairment).
That all is just a thumbnail sketch, and not enough of a foundation for a discussion. It suggests a lead to the non-thalamic necessities for consciousness. That lead could be spurious, though, were it to turn out the intralaminar nuclei are being
partially affected in this situation. I've never seen mention of it though.