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Responsiveness before, during, and after spike-wave paroxysms

Section on Epilepsy, Applied Neurologic Research Branch, Collaborative and Field Research, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, and the Department of Neurology, University of Virginia School of Medicine, Charlottesville.

In 26 patients 5 to 20 years of age with absence seizures, 413 auditory reaction times were determined by a paroxysm detection device during 310 spike-wave paroxysms. All reaction times during the 1 second before a paroxysm were within normal limits, but only 43 percent of reaction times at the onset of a paroxysm were normal and after a delay of 0.500 second into a paroxysm, only 20 percent were normal. After 4 seconds of spike-wave discharge, 52 percent of reaction times were normal. Responsiveness was recovered quickly after a paroxysm. The degree of impairment of response to auditory stimuli markedly decreased when spike-wave discharge was fully generalized. The degree of maximal impairment of auditory responsiveness was the same in paroxysms of both long and short duration. Thus, any spike-wave paroxysm, regardless of duration, can impair consciousness, and therapy for absence seizures should aim at controlling all spikewave paroxysms, not just the longer bursts.

Dr. Penry's address is Building 36, Room 5D-10, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20014.

This paper was read at the twenty-fifth annual meeting of the American Academy of Neurology, Boston, April 1973.

This work was supported in part by a grant (RR-304) from the General Clinical Research Centers Program of the NIH Division of Research Resources.

Received for publication February 4, 1974.

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