Epileptic disorders, brain damage from any cause, or substance abuse such as alcohol can lead to twilight states, characterized by a narrowing of the field of consciousness and the presence of automatic, involuntary movements.

In this article we will describe what the twilight state is and what its most common symptoms and causes are . 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?

Twilight states are transitory alterations of alertness, attention and consciousness . It is associated with feelings of mental confusion, temporospatial disorientation, decreased sensory reactivity, amnesia from the episodes and automatic and impulsive behaviour. However, there is no obscurity of consciousness.

The alteration of consciousness characteristic of twilight states can have a very different degree in each case. Moreover, 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 usually appear in wider contexts; in this sense epileptic disorders and the abuse of certain types of substances are particularly relevant . Thus, the set of symptoms that we call “twilight state” is mainly due to brain alterations, whether they are of a temporary or chronic nature.

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

Narrowing of the field of consciousness

The twilight state falls into the category of alterations by narrowing of the field of consciousness , which are characterized by the dissociation between observable behaviour and cognitive phenomena: the flow of thoughts and perceptions is interrupted but behaviour still appears more or less normal.

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

In the alterations by narrowing of the field of consciousness, a decrease in the level of cerebral alert is produced, and therefore of the capacity of attention. Consequently, disorientation appears, both spatial and temporal, and amnesia of the episode is produced once it has ended . Sensory reactivity is partly maintained.

Main symptoms: Automations and drives

The automatisms and impulses are the main signs of the twilight state and of the alterations due to narrowing of consciousness in general. These are the clearest manifestations of the affectation of consciousness and of the automatic behaviours that define this type of phenomena.

The term “automatism” refers to episodes of motor activity that take place with a diminished level of consciousness , and therefore have an automatic and involuntary character. 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 (perplexity and fear are very characteristic) or words and other sounds. Chewing automatisms are especially frequent. Usually these phenomena reproduce the behavior that the person was executing before the episode.

Drives are less common than automatisms . These are impulsive behaviours that do not derive from a cognitive and voluntary basis, and the most common is wandering, which consists of the person walking aimlessly for an extended period of time, sometimes throughout the entire episode.

Causes of 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 seizures of great evil, and specifically with the epileptic aura , that is, with 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. One type of twilight state that has received special attention is the alcoholic variant, in which the combination of one of these episodes and alcohol consumption, even if it is in small amounts, can cause very aggressive behavior.

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

The literature on the twilight state 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 several higher 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 involving many parts of the brain, and their effect spreads affecting many groups of neurons, so it is very complicated to locate what is the root of what occurs in cases of twilight state.

Scientific research must therefore continue to make progress in order to understand the main cause of this phenomenon and to be able to remedy it.