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Videotape analysis of 76 attacks in 14 epileptics showed two electro-clinical types of psychomotor attacks. The first and most common type had three clinical phases, consisting of an initial motionless stare, stereotyped movements, and reactive automatisms during impaired consciousness. The second and less common type started with stereotyped and reactive automatisms. In the first type, focal temporal or lateralizing features were common. In the second type, there were only diffuse changes in the electroencephalogram. The value of recording attacks with nasopharyngeal electrodes was emphasized by a high yield for focal-lateralizing electroencephalographic features.

Automatisms of 691 complex partial seizures in 79 patients were studied on closed-circuit television (CCTV) and by electroencephalography. Simple stereotyped perseverative automatisms such as chewing, swallowing, and fumbling with clothes or sheets followed an initial motionless stare and lapse of consciousness in type I attacks. Ambulatory automatisms, bilateral arm and leg perseverative movements, and tonic adversive head or eye movements (or both) characterized type II attacks, in which a motionless stare was not observed. Type III started with a drop attack followed by confusion, amnesia, and gradual recomposure. Some type II and III attacks are suspected to begin in areas outside the temporal lobe, while type I attacks are thought to originate from the temporal lobe. Further studies using CCTV and depth electrode recordings are necessary to verify these suspicions.

The design for the comparative evaluation of the efficacy and toxicity of phenobarbital, phenytoin, primidone, and carbamazepine is outlined. A double-blind prospective study of a sufficient number of patients can determine the optimum drug to use initially for partial and generalized tonic-clonic seizures in adults. The rationale for methods defines the major parameters that should be addressed in order to determine optimum drug for longterm seizure therapy. Major problems in the function of such a project include aspects of sample size attainment, screening/recruitment, non-drug-related losses, and adjustments to the ongoing protocol. The design, with modifications, can be used to study other antiepileptic drugs and other types of seizures.