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February 1984

Seizures in Paroxysmal Episodes of Unconsciousness-Reply

Author Affiliations

Section of Neurology Department of Medicine Marshall University Huntington, WV 25701

Arch Neurol. 1984;41(2):136. doi:10.1001/archneur.1984.04050140034012

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In Reply.  —We agree with the observations of Drs Forster, Dasheiff, and Patterson regarding the origin of paroxysmal episodes of unconsciousness in a quadriplegic patient. Certainly, the differential diagnosis of such events includes seizures. Though the patient of Forster and Dasheiff was quadriplegic, there was evidence, at least by history, of positive neurologic phenomena during the event, ie, tongue biting, which is quite suggestive of a generalized seizure. The diagnosis was further strengthened by the abnormal EEG.Our patient never sought medical attention for his episodes of unconsciousness. After his death, his family members, with whom he lived, were extensively interviewed by two of us (C.E.M. and J.L.E.). They had witnessed many of his events and denied emphatically any tongue biting, versive head or eye movements, tonicclonic movements of either arm (he still had some upper-extremity function), or other stigmata of a seizure.Postmortem neuropathologic examination disclosed a cystic cavity, maximal at

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