Conversational analysis of consciousness during seizures.

Objective: The objectives of the study were to 1) investigate how patients with epilepsy describe the subjective, conscious experience of having a seizure and 2) determine whether certain themes and descriptions correspond to specific types of epilepsy.

Methods: We interviewed thirteen patients with electroencephalographically confirmed epilepsy about their subjective experience of having a seizure and used conversational analysis (CA) to analyze the language they used to describe this experience.

Results: Seven patients had focal to bilateral tonic-clonic seizures (FBTCS), 7 had focal impaired awareness seizures (FIAS), 1 had focal aware seizures (FAS), and one had generalized onset tonic-clonic (GTC) seizures. Three had multiple types of seizures. Focal seizure origin was frontal in 2 patients, right hemisphere in 1, parieto-occipital in 1, and temporal in 8. Focal to bilateral tonic-clonic and GTC seizures were most frequently associated with descriptions of a total loss of consciousness (n = 8), whereas FIAS were most frequently associated with a perceived loss of consciousness but able to describe some aspects of being unconscious (n = 5). Temporal seizures most frequently accompanied reports of memory loss/impairment (n = 4). Ten patients provided specific descriptions of the transition between the interictal and ictal state or auras. Descriptions consciousness and unconsciousness ranged significantly, resembling a continuum rather than corresponding to distinct levels.

Conclusion: The subjective experience of consciousness for patients with epilepsy may differ by seizure type and origin. These may reflect different involvement of brain regions involved in producing consciousness and arousal. Conversational analysis and narrative approaches can significantly aid clinicians in the diagnosis and management of epilepsy.