Editorial commentary: How does the localised ictal activity of a temporal lobe seizure generate a global impairment of consciousness? And how do brief temporal lobe seizures beget long-lasting interictal changes in cognition? Dr Englot and his colleagues have pursued these questions over the past decade through several innovative studies, and have convincingly implicated the ascending reticular activating system (ARAS) as an important contributor.1–3 In their most recent JNNP study4, they further incriminate the ARAS, although now as a source of interictal neurocognitive impairment. To read the full article, log in using your NHS OpenAthens details.