Epilepsy and arousal

Epilepsy is characterized by recurrent seizures. Certain seizure types cause dysregulation of arousal and conscious awareness, whereas others relatively spare those impairments. Prior studies suggest that whether impaired consciousness is present or not during seizures largely depends on whether affected areas include cortical and subcortical regions that regulate consciousness. In absence epilepsy and temporal lobe epilepsy, consciousness impairments have been relatively well studied. Accordingly, we will discuss cellular and circuit mechanisms underlying dysregulation of consciousness in those types of epilepsies. Mechanistically, normal coordinated network activity (e.g., gamma oscillations) plays a key role in maintaining consciousness, whereas abnormal network activity in epilepsy (e.g., 3- to 4-Hz spike-and-wave discharges in absence seizures) is thought to be closely associated with dysregulation of consciousness. Thus, we will stress coordinated network activity in conjunction with its critical role in normal consciousness and dysregulation of consciousness in epilepsy. Finally, we will consider treatment strategies for dysregulation of consciousness in epilepsy and future directions.