Epileptic disorders, brain injuries due to any cause or the abusive consumption of substances such as alcohol can cause the appearance of twilight states, characterized by the narrowing of the field of consciousness and the presence of automatic and involuntary movements.
In this article we will describe What is the twilight state and what are its symptoms and causes? more common. We will focus especially on the associations between this phenomenon and broader psychological disorders, as well as on its two most typical observable signs: automatisms and impulses.
What is the twilight state?
The twilight states are transient alterations in alertness, attention and consciousness It is associated with sensations of mental confusion, temporal-spatial disorientation, decreased sensory reactivity, episode amnesia, and automatic and impulsive behaviors. However, there is no clouding of consciousness.
The alteration of consciousness characteristic of twilight states can have a very different degree in each case. Furthermore, the different areas that make up consciousness are not affected in an equivalent way, but rather each attentional function may present more or less significant alterations.
These phenomena generally appear in broader contexts; In this sense, they are especially relevant epileptic disorders and the abuse of certain types of substances Thus, the set of symptoms that we call the “twilight state” is mainly due to brain alterations, whether temporary or chronic.
In general, twilight states have a sudden beginning and end, and usually last several hours; It is not uncommon for them to last for days. Its intensity may vary depending on the severity of the brain alterations that cause the symptoms. The person usually does not remember the episode once it has ended.
Narrowing of the field of consciousness
The twilight state falls within the category of alterations due to narrowing of the field of consciousness which are characterized by the dissociation between observable behavior and cognitive phenomena: the flow of thoughts and perceptions is interrupted but behavior continues to appear more or less normal.
However, in this type of disorders, of which twilight states are the most representative example, the behavior has an automatic nature. This is manifested in the appearance of automatisms (continuations of the movements prior to the episode) and impulses, which lead to wandering.
In alterations due to narrowing of the field of consciousness, there is a decrease in the level of cerebral alertness, and therefore the capacity for attention. As a result, disorientation appears, both spatially and temporally, and amnesia of the episode occurs once it has ended Sensory reactivity is partly maintained.
Main symptoms: automatisms and impulses
Automations and impulses are the main signs of the twilight state and alterations due to narrowing of consciousness in general. These are the clearest manifestations of the impairment of consciousness and the automatic behaviors that define this type of phenomena.
The term “automatism” refers to episodes of motor activity that occur with a decreased level of consciousness , and therefore have an automatic and involuntary character. Coordination of movements is more or less satisfactory, although the narrowing of consciousness is usually evident to observers.
The most common automatisms involve manual gestures, walking movements, facial expressions (those of perplexity and fear are very characteristic) or words and other sounds. Masticatory automatisms are especially common. Generally these phenomena reproduce the behavior that the person performed before the episode.
Impulsions are less common than automation These are impulsive behaviors that do not derive from a cognitive and voluntary basis, and the most common is wandering, which consists of the person walking aimlessly for a long period of time, sometimes throughout the entire episode.
Causes of the twilight state
The typical cause of twilight states are epileptic seizures, which occur as a consequence of alterations in the electrical activity of the brain. In this sense we can associate the term with grand mal seizures, and specifically the epileptic aura that is, the set of symptoms and signs that precede the seizures in these cases.
Another common cause of the twilight state is intoxication by psychoactive substances. A type of twilight state to which special attention has been devoted is the alcoholic variant, in which the combination between one of these episodes and the consumption of alcohol, even if it is in small quantities, can cause very aggressive behavior.
Brain lesions and alterations of other types, in addition to those typical of epilepsy, also sometimes cause alterations due to a narrowing of the field of consciousness. In this sense we can highlight ictal twilight states, during which impulses to wander are very frequent
In the literature related to the twilight state, its association with other phenomena is also mentioned: schizophrenia, somnambulism and hysteria are perhaps the most relevant. However, there is not much information regarding the differential characteristics of the twilight state in these psychopathological contexts.
Concluding
The twilight state is a mental alteration that affects several higher psychological processes that, due to its complexity, make this phenomenon complicated to treat. Epilepsy in general, altered states of consciousness due to substance use, and brain injuries and everything they entail, trigger processes that involve many parts of the brain, and their effect spreads, affecting many groups of neurons, so that It is very difficult to locate the root of what happens in cases of twilight state.
Therefore, it is necessary for scientific research to continue progressing to understand the main cause of this phenomenon and to be able to remedy it.