ICTAL OROALIMENTARY AUTOMATISMS WITH PRESERVED CONSCIOUSNESS - IMPLICATIONS FOR THE PATHOPHYSIOLOGY OF AUTOMATISMS AND RELEVANCE TO THE INTERNATIONAL CLASSIFICATION OF SEIZURES

A patient showing seizures presenting ictal automatisms with preserved consciousness is reported. A 30-year-old, right-handed man with norma l development and without family history of epilepsy was referred for surgical treatment of epilepsy. At 15 he began to have seizures, start ing with an epigastric aura, occasionally developing automatisms (lip- smacking, chewing), sometimes followed by tonic-clonic convulsions. At the time of referral, he averaged six convulsive seizures per year an d one nonconvulsive per week. His sleep EEG showed sharpened slow acti vity over the right anterior quadrant magnetic resonance imaging (MRI) showed a benign lesion in the mesial aspect of the right occipital lo be. Simultaneous video monitoring and intracranial EEG with subdural s trips recording from the right temporal and occipital lobes was undert aken. During one seizure, he had pronounced oroalimentary automatisms while holding a conversation with a technician, answering her question s, and explaining details of his seizures. Memory of this event was pr eserved. At seizure onset, spike activity was seen at the mesial occip ital strips. At mid-seizure, high-voltage sharpened delta was seen thr oughout the right hemisphere. Left-sided scalp electrodes remained rel atively uninvolved. The lesion, a dysembryoplastic neuroepithelial tum our was removed. Surgery was followed by abolition of seizures describ ed. Because it is agreed that complex partial seizures require impaire d consciousness, a history of automatisms with retained consciousness usually suggests nonepileptic attacks. This case suggests that automat isms in epileptic seizures can take place with minimal loss of conscio usness, particularly if there is widespread but unilateral involvement . The need for a revision of the International Classification is sugge sted.