The patient later had a similar seizure which was recorded on video EEG, and, just before the seizure, Devinsky noted, the patient was slow to respond and disoriented regarding time and place:
When asked if there was anything wrong, he replied: “nothing is wrong, I am doing well . . . I am very happy” and when asked whether he knew where he was, he replied with a smile and a surprised look: “Of course I know. I am in heaven right now; . . . I am fine. ”
He remained in this state for ten minutes, then went on to a generalized seizure. Later, he remembered his ecstatic aura “as if it were a vivid and happy dream” from which he had now awoken, but he had no memory of the questions put to him during the aura.
49. She ran as a Republican in a district that had been Democratic for a very long time, and lost by only a narrow margin. Whenever she appeared in public during her campaign, she said that God had told her to run, and this apparently persuaded thousands of people to vote for her, despite her manifest lack of political experience or skills.
50. The evidence here has been discussed in a number of books, including Kevin Nelson’s
51. Before seeing Ellen O., I had never heard of visual perseveration of such duration. Visual perseveration of a few minutes may be associated with cerebral tumors of the parietal or temporal lobes or may occur in temporal lobe epilepsy. There are a number of such accounts in the medical literature, including one by Michael Swash, who described two people with temporal lobe epilepsy. One of them had attacks in which “his vision seemed to become fixed, so that an image was retained for several minutes. During these episodes the real world was seen through the retained image, which was clear at first, but then gradually faded.”
Similar perseveration may occur with damage or surgery to an eye. My correspondent H.S. was blinded by a chemical explosion at the age of fifteen but had some sight restored by corneal surgery twenty years later. Following the operation, when his surgeon asked if he could now see the surgeon’s hand, H.S. replied, “Yes”—but then was astonished to see the hand, or its image, preserving its exact shape and position, for several minutes afterward.
52. In a letter to me, James Lance commented, “I have never encountered hallucination embracing information from the surroundings like Mr. H.’s.”
53. In addition to the overt delirium that may be associated with life-threatening medical problems, it is not uncommon for people to have slight delirium, so mild that it would not occur to them to consult a physician, and which they themselves may disregard or forget. Gowers, in 1907, wrote that migraine is “often attended by quiet delirium of which nothing can be subsequently recalled.”
There has always been inconsistency in defining delirium, and as Dimitrios Adamis and his colleagues pointed out in their review of the subject, it has frequently been confused
with dementia and other conditions. Hippocrates, they wrote, “used about sixteen words to refer to and name the clinical syndrome which we now call delirium.” There was additional
confusion with the medicalization of insanity in the nineteenth century, as German Berrios has noted, so that insanity was referred to as
54. Just such an appearance of delirious images when closing the eyes, and their disappearance when the eyes are opened, is described by John Maynard Keynes in his memoir “Dr. Melchior”:
By the time we were back in Paris, I was feeling extremely unwell and took to my bed two days later. High fever followed. . . . I lay in my suite in the Majestic, nearly
delirious, and the image of the raised pattern on the
