Twilight State: What It Is, Symptoms And Causes

This type of alteration of consciousness causes the attention span to be narrowed.

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 by the presence of automatic and involuntary movements.

In this article we will describe what the twilight state is and what its symptoms and its most common causes are. We will pay special attention to the associations between this phenomenon and broader psychological disorders, as well as its two most typical observable signs: automatisms and drives.

What is the twilight state?

Twilight states are transitory disturbances of alertness, attention and consciousness. It is associated with feelings of mental confusion, time-space disorientation, decreased sensory reactivity,  amnesia of episodes, 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. In addition, the different areas that make up consciousness are not affected in an equivalent way, but each attentional function can present more or less significant alterations.

These phenomena generally appear in broader contexts; In this sense, epileptic disorders and the abuse of certain types of substances are especially relevant . Thus, the set of symptoms that we call the “twilight state” is mainly due to brain alterations, be they temporary or chronic.

Twilight states generally have a sudden onset and end, and usually last for several hours; it is not uncommon for them to last for days. Its intensity may vary depending on the severity of the brain changes that cause the symptoms. The person usually does not remember the episode after it is over.

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 the behavior continues to have an appearance more or less normal.

However, in this type of disorder, of which twilight states are the most representative example, the behavior has an automatic character. This is manifested in the appearance of automatisms (continuations of the movements prior to the episode) and impulses, which lead to ambulation.

In alterations by narrowing the field of consciousness, there is a decrease in the level of brain alertness, and therefore in the capacity for attention. Consequently, disorientation appears, both spatial and temporal, and the episode is amnesia once it has ended. Sensory reactivity is maintained in part.

Main symptoms: automatisms and impulses

The automatisms and the impulses are the main signs of the twilight state and of the alterations by narrowing of the conscience in general. These are the clearest manifestations of the affectation of consciousness and of the automatic behaviors that define this type of phenomenon.

The term “automatism” refers to episodes of motor activity that occur with a decreased level of consciousness, and therefore have an automatic and involuntary nature. The 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. Chewing automatisms are especially frequent. In general, these phenomena reproduce the behavior that the person performed before the episode.

Drives are less common than automatisms. These are impulsive behaviors that are not derived 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 is  epileptic seizures, which occur as a result of alterations in the electrical activity of the brain. In this sense, we can associate the term with the great evil seizures, and specifically the epileptic aura, that is, the set of symptoms and signs that precede seizures in these cases.

Another common cause of the twilight state is intoxication by psychoactive substances. One type of twilight state to which special attention has been paid is the alcoholic variant, in which the combination of one of these episodes and the consumption of alcohol, even if it is in small quantities, can cause very aggressive behaviors.

Brain injuries and alterations of other types, in addition to those that are typical of epilepsy, also sometimes cause alterations by narrowing the field of consciousness. In this sense, we can highlight the ictal twilight states, during which ambulation impulses are very frequent.

The twilight state literature also mentions its association with other phenomena: schizophrenia,  sleepwalking 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 verios superior psychological processes that, due to their complexity, make this phenomenon difficult to treat. Epilepsy in general, altered states of consciousness due to substance use, and brain injuries and all that 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 what is the root of what happens in cases of twilight state.

Therefore, it is necessary that scientific research continues to progress to know the main cause of this phenomenon and be able to remedy it.

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