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NEUROLOGY 1978;28:239
© 1978 American Academy of Neurology

Prolonged epileptic twilight states

Continuous recordings with nasopharyngeal electrodes and videotape analysis

MELVIN A. BELAFSKY, M.D., SANDY CARWILLE, B.S.N., PATRICIA MILLER, B.S.N., GWEN WADDELL, M.S.N., JEAN BOXLEY-JOHNSON, B.S.N. and A. V. DELGADO-ESCUETA, M.D.

EEG Unit, Department of Neurology, Wadsworth VA Hospital Center and University of California at Los Angeles School of Medicine: and the Epilepsy Center, Division of Neurology, Durham VA Hospital and Duke University School of Medicine, Durham, North Carolina.

Confusion, speech arrest, automatic behavior, and amnesia characterize the prolonged twilight states of both petit ma1 and psychomotor status. However, in psychomotor status two electroclinical phases were differentiated: (l) A continuous twilight state with partial responsiveness and reactive automatisms interrupted by (2) staring, total loss of responsiveness, and stereotyped automatisms. During the first phase, with reactive behavior, the EEG showed bilateral diffuse slowing. During the second phase, with stereotyped automatisms, there were spreading right temporal 4- to 12-Hz discharges. Petit ma1 status had one continuous twilight state, during which both stereotyped and reactive automatisms merged as 1.5- to 4-HZ spike-wave complexes, and bimedial temporal 4-Hz discharges' appeared in the EEG.

Requests for reprints should be addressed to: Dr. Delgado-Escueta, EEG Unit, Wadsworth VA Hospital Center, Los Angeles, CA 90073.

Accepted for publication July 22, 1977.






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