Abstracts

RATIONALE: To review John Hughlings Jackson[ssquote]s theories on the relationship between epilepsy and consciousness.
METHODS: We reviewed the publications of Hughlings Jackson, to summarize his writings on the [dsquote]dreamy state[dsquote] and its associated signs and symptoms, as well as to describe his correlations of the [dsquote]dreamy state[dsquote] with organization of consciousness.
RESULTS: Hughlings Jackson described the [dsquote]dreamy state,[dsquote] which he also described as an heightened intellectual state, or [dsquote]overconsciousness.[dsquote] He clinically associated the [dsquote]dreamy state[dsquote] with [dsquote]crude sensations[dsquote] of fear, smell and taste, and an unusual epigastric sensation, and noted the association of alteration of consciousness with this seizure type. He eventually associated the [dsquote]dreamy state[dsquote] and its associated signs and symptoms with lesions of the mesial temporal region, which he called the [dsquote]uncinate group of fits.[dsquote] Hughlings Jackson saw the study of epilepsy as a key in understanding brain organization and function, and therefore related the [dsquote]dreamy state[dsquote] to organization of consciousness. Using his theory of hierarchical brain function, his observations of the [dsquote]dreamy state[dsquote] led him to postulate three degrees of consciousness, each with an objective and subjective component. In the isolated [dsquote]dreamy state,[dsquote] or [dsquote]slightest[dsquote] seizure, the deficit of perception of ongoing events represented a relative decrease in the first degree of objective consciousness, while the perceived heightening of intellectual abilities represented an associated increase in the first degree of subjective consciousness. In more severe seizures, the complete loss of postictal recollection of ictal events represented a deficit in the second degree of object consciousness, while the crude sensations represented an increase in the second degree of subject consciousness. Coma represented a deficit of the third degree of object consciousness, while mania represented an increase the third degree of subject consciousness.
CONCLUSIONS: Hughlings Jackson described and localized the syndrome of mesial temporal epilepsy with his descriptions of the [dsquote]dreamy state.[dsquote] However, his interest in the [dsquote]dreamy state[dsquote] went beyond the characterization of the syndrome. He used his observations of the [dsquote]dreamy state[dsquote] as the primary source to construct his theories of consciousness.