[Epileptic auras: classification, pathophysiology, practical usefulness, differential diagnosis and controversials].

Area of Science:

• Neurology
• Epileptology
• Clinical Neuroscience

Context:

• Epileptic auras are the initial manifestation of seizures, occurring before consciousness loss and retaining memory.
• Simple partial seizures consist entirely of an aura, stemming from localized, abnormal neuronal discharge.
• Surface electroencephalography often fails to detect changes during isolated auras.

Purpose:

• To elucidate the diverse clinical manifestations of epileptic auras.
• To enhance the understanding of aura pathophysiology and characteristics.
• To explore the association between auras and specific types of focal epilepsy.

Summary:

• Auras exhibit extraordinary clinical diversity, with specific types linked to epilepsy localization (e.g., temporal vs. extratemporal).
• Viscerosensorial and experiential auras are common in temporal lobe epilepsy; fear is linked to mesial temporal discharges.
• Sensory auras (visual, gustatory, olfactory, somatosensory) and their potential etiologies (e.g., tumors) are described.
• Classification challenges exist for certain auras (motor, cephalic, sexual), with a broad differential diagnosis.

Impact:

• Improved understanding of aura characteristics aids in precise diagnosis of focal epilepsy.
• Recognizing diverse aura presentations can guide etiological investigations, including identifying potential underlying pathologies like tumors.
• Differentiating auras from other neurological and psychiatric conditions is essential for effective patient management.