Twilight attack

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Twilight attack is a clinical term for states of short-term changes in consciousness. In contrast to the twilight states, which are far less clearly delimited in terms of time, this paroxysmal state lasts, depending on the author, about 30 seconds to 2 minutes or, more generally, it is specified with a duration of "seconds to minutes". It can go away gradually or suddenly. Twilight attacks can turn into a post-paroxysmal twilight state. They can even appear as the aura of a grand mal seizure. According to the definition by Meyer-Mickeleit (1950, 1953), twilight attacks are “brief paroxysmal changes in consciousness that are usually accompanied by motor automatisms, vegetative symptoms, senseless action and speech [...]. They are associated with hallucinations and other abnormal experiences more frequently than other types of seizures . ”This definition not only encompasses a wide range of clinical course forms, it also gives rise to a large number of synonymous names such as psychomotor seizures as a combination of multiple motor and psychopathological symptoms. The term temporal lobe epilepsy , which is also used synonymously, cannot be understood as a completely identical term. It is merely a synonymous term, as can be seen from the following clinical-topical aspects.

Topistic brain research

Attempts have been made to establish topical correlations between certain forms of twilight attacks and a constant pathological-anatomical substrate within the brain. A localized (focal) system of epilepsies could thus be applied to twilight attacks, similar to the Jackson attacks. A relationship between temporal lobes and psychomotor symptoms has been established with a certain frequency . It has therefore also been spoken of "actual twilight attacks". However, not every psychomotor seizure corresponds to temporal lobe epilepsy. Not be depending on the author in 30-50% of cases stove notice in the temporal lobe. In particular, psychomotor seizures in childhood are not always due to a focus in the temporal lobe. On the other hand, not all of the foci that can be detected in the EEG within the temporal lobe are associated with psychomotor seizures. Other brain structures such as the limbic system also play a central role in the twilight attacks. The Ammon's horn in particular is the most convulsive part of the entire brain. Even small tumors, inflammatory foci or scars in the topical vicinity of the Ammon’s horn that do not destroy it themselves often result in twilight attacks. Damage to the Ammon's horn ( Ammon's horn sclerosis ) is said to occur during childbirth as a result of being trapped in the tentorium slit . As early as 1889, John Hughlings Jackson (1835–1911) recognized that psychomotor seizures spread from the basal temporal lobe and described them as uncinate fits 'Uncinatus seizures' , see Uncus gyri parahippocampalis . In 1957, Hallen further subdivided this topical determination into clinical terms.

Individual evidence

  1. ↑ a b c d e f Gustav Bodechtel : Differential diagnosis of neurological diseases . Georg Thieme, Stuttgart 3 1974, ISBN 3-13-309103-4 ; Pp. 1022-1026.
  2. ↑ Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology . Urban & Schwarzenberg, Munich 3 1984; P. 33 on Wb.-Lemma "Seizure, psychomotor".
  3. ↑ RW Meyer-Mickeleit: About the so-called psychomotor attacks, the twilight attacks of epileptics . Arch. Psychiatr. 184 (1950) 271-272.
  4. ↑ RW Meyer-Mickeleit: The twilight attacks as a characteristic type of attack of temporal epilepsy . Psychomotor seizures, equivalents, automatisms. Nervenarzt 24 (1953) 331-346.
  5. ^ E. Ketz: Clinical analysis of psychomotor epilepsy . Progress Med. 86 (1968) 545.
  6. ↑ E. Ketz, D. Xanthakos: The importance of epileptic seizures in temporal lobe tumors . Zbl. total Neurol. Psychiatry. 192 (1969) 2.
  7. ↑ C. Bernoulli: Psychomotor epilepsy . Ther. Switch 24 (1967) 512-521.
  8. ^ A b c Hans-Günther Niebeling : Introduction to electroencephalography . Springer, Berlin Heidelberg New York 1980, ISBN 3-540-09863-1 ; (a + b) p. 249; (c) p. 241.
  9. ↑ Peter Duus : Neurological-topical diagnostics. Anatomy, physiology, clinic. Georg Thieme, Stuttgart, 5 1990, ISBN 3-13-535805-4 ; P. 279.
  10. ^ O. Hallen: Das Oral-Petit mal . Description and dissection of the fit as uncinate and psychomotor. fit designated equivalents. German Z. Nervenheilk. 171 (1954) 236; 176 (1957) 321