Prolonged twilight state and automatisms

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Abstract
A prolonged state of mental confusion was associated with a unilateral seizure focus in the left medial anterior temporal lobe in a 39 year old patient with psychomotor status. Two electroclinical phases are differentiated: (1) a continuous twilight state with reactive automatisms interrupted every 10 minutes by (2) staring, total loss of responsiveness, and stereotyped gutomatisms. During the first clinical phase the electroencephalogram showed continuous, focal sharply contoured slow waves in the left anterior temporal areas preponderant medially. During the second clinical phase, 6 to 10 Hz rhythms engaged both medial temporal lobes and then progressively increased in amplitude and decreased in frequency to 3 to 5 Hz waves. A subcortical mechanism is suggested for both reactive and stereotyped automatisms.

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