Abstracts

Rationale:
To assess completeness of memory preservation for seizure elements in patients with focal epilepsy and its role for classification as focal aware vs. unaware seizures.
Method:
Results of questionnaires filled out by patients on seizures elements they remember prior to in-patient video-EEG monitoring were compared to video-documented seizures semiology in 90 consecutive patients with focal epilepsy who were willing to participate in prospective semiology assessment and subsequent video presentation of seizures.  Classification of seizures was performed according to (1) the 1981 ILAE seizure classification defining consciousness as preserved memory or reactivity and (2) according to the 2017 ILAE seizure classification defining awareness based on preserved memory only. Results14/90 patients had seizures classified as simple partial seizures based on preserved reactivity and/or memory according to the 1981 ILAE classification, whereas only 1/90 patients was classified as having focal aware seizures based on completely preserved memory for all seizure elements. This was related to frequent memory impairment also for subjective phenomena reported during seizures: only 45.6% of documented octal subjective phenomena were remembered in the interictal phase. Moreover, only 12% of autonomic seizure elements and 5.9% of motor phenomena were correctly recalled by patients.
Conclusion:
Completely intact memory for details of seizure elements is rare in patients with focal epilepsy. When a classification as ""focal aware"" is based on intact memory without considering responsiveness during seizures, the majority of seizures classified as ""simple partial"" did not fulfill criteria for ""focal aware"", and simple mapping of earlier seizures classifications to the new classification cannot be performed. Complete recall was present in only one out of 90 patients studied here.
Funding:
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