Based on the response of the patient at the time and after the attack, a conclusion is drawn about the state of consciousness. Thus, a complete impairment of consciousness is characterized by the absence of answers to questions at the time of the attack, failure to execute commands, complete amnesia (the inability to recall the word and subject shown at the time of the attack).
For a partial disturbance of consciousness is also characterized by the lack of answers to questions at the time of the attack, the failure of commands, however, amnesia is partial, i.e. the patient remembers that he was called the word and showed the subject, but could not remember which word or which object. With the patient intact, the patient is able to answer questions, execute commands at the moment of an attack, remember the named object and word after the attack.
The group of complex partial seizures also includes the so-called psychomotor seizures, which are characterized by automatisms or automatic behavior, somatomotor activity, and various degrees of impairment of consciousness. Often complex partial seizures are preceded by an aura.
The aura is a part of the attack that immediately precedes the loss of consciousness and which the patient remembers after his recovery. In most patients, the aura is characterized by a short duration (from several seconds to several minutes). The sensations experienced during the aura are due to the involvement of a specific functional area of the cerebral cortex in the epileptic process, which determines the specificity of the aura symptoms. A distinctive feature of epileptic auras is their stereotype — repeatability from an attack to an attack.
The famous French psychiatrist Mangan (1883) wrote: “The aura is remarkable for its remarkable constancy: the form, localization, the course of this symptom are indeed so identical in the same subject during all his attacks, that the appearance of this symptom portends an undoubted closeness of the seizure … “
Depending on the nature of the sensations, epileptic auras are divided into: – somatosensory;
- mental (emotional and intellectual), etc.
The most important clinical symptom
psychomotor attacks are automatisms – stereotyped behavior during an attack. Automatization manifestations are extremely variable. Penry, Dreifuss (1969) offered
allocate de novo and perseverative automatisms.
De novo automatisms arise from the moment the seizure debuts and continue throughout the seizure.
Perseverative automatisms are observed until the onset of the attack and automatically continue throughout the entire paroxysm.
By the nature of the manifestations automatisms are divided into:
- de-alimentary – reopening or closing the mouth, chewing, smacking, swallowing, licking the lips;
- mimetic – grimaces, smile, violent laughter;
- gestural – prehensile, rolling movements in the hands;
- ambulatory – movements of the body or the whole body; the patient re-sits, gets up, can
- verbal (cry, roar, moan, lowing); perhaps, on the contrary, the stopping of speech; – pedaling (movements with legs as when riding a bicycle).