The epileptic blip syndrome: Clinical and neurophysiological clues supporting the delineation of a concept
Résumé
Objectives: Interictal electroencephalographic discharges (IED) are very short-lasting activities that are not supposed to interfere with cognition. As IED impacts waking activity that supports the stream of consciousness, it should be expected that these events could be responsible for momentary breaks in this flow. Thirty years ago, J.W. Lance described the blip syndrome that echoes our premise. A blip was defined as a very short-lasting sensation of impending loss of consciousness. Could this sensation be related to IED? In the present study, we proposed: 1) clinical, 2) neurophysiological, and 3) theoretical arguments suggesting that a blip of consciousness can be of epileptic origin. Content: 1) Clinic: a 15-year-old patient was presenting with generalized spike-wave discharges (GSWD) followed by a gesture consisting of touching his forehead with his hand. Asked about this movement, he reported an indefinable and very brief sensation occurring “inside his head”. This observation suggests that the patient could detect the impact of GSWD on the stream of consciousness, and attributes it to an internal sensation like "a blip on screen”. 2) Neurophysiological: in another patient, GSWD was associated with a significant decrease in power in alpha-band activity. This suggests that GSWD can induce a brief attentional lapse impacting resting activity. 3) Literature: “phantom absences” are specific epileptic seizures described as episodes of partial impairment of consciousness that correlate with GSWD occurrence. These arguments give some support that a blip of consciousness could be of epileptic origin.
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