Repeated consciousness-impairing seizures weaken the reticular activating system’s connections, possibly leading to the baseline neurocognitive dysfunction these patients experience

How does the localised ictal activity of a temporal lobe seizure generate a global impairment of consciousness? And how do brief temporal lobe seizures beget long-lasting interictal changes in cognition? Dr Englot and his colleagues have pursued these questions over the past decade through several innovative studies, and have convincingly implicated the ascending reticular activating system (ARAS) as an important contributor.1–3 In their most recent JNNP study,4 they further incriminate the ARAS, although now as a source of interictal neurocognitive impairment.

According to the model previously proposed by Englot …