Twilight state: what is it, symptoms and causes

Epileptic disorders, brain injuries due to any cause or the abusive use 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.

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

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What is the twilight state?

Twilight states are transient disturbances in alertness, attention, and consciousness. It is associated with feelings of mental confusion, time-space disorientation, decreased sensory reactivity, amnesia of automatic and impulsive episodes and 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, 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, be they of a temporary or chronic nature.

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 alterations causing the symptoms. The person usually does not remember the episode after it is over.

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Narrowing of the field of consciousness

The twilight state falls within the category of disturbances due to narrowing of the field of consciousness, which are characterized by the dissociation between observable behavior and cognitive phenomena: interrupts the flow of thoughts and perceptions but the behavior continues to appear 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 due to narrowing of 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 amnesia of the episode occurs once it has ended. Sensory reactivity is partially maintained.

Main symptoms: automatisms and impulses

Automatisms and drives 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 "automation" 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. 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 are 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 crisis of great evil, and specifically the epileptic aura, that is, to 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 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 amounts, can cause very aggressive.

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.

In the literature on 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 disorder 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 its 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 state twilight.

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