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Multiple auras: clinical significance and pathophysiology.

P Widdess-Walsh1, P Kotagal, L Jeha

  • 1Cleveland Clinic Epilepsy Center, Cleveland Clinic, Cleveland, OH 44195, USA.

Neurology
|August 22, 2007
PubMed
Summary

Patients experiencing multiple seizure auras often have epilepsy in the right hemisphere. These individuals may benefit from epilepsy surgery, suggesting a localized seizure origin.

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Area of Science:

  • Neurology
  • Epileptology
  • Clinical Neuroscience

Background:

  • Partial epilepsy can manifest with diverse aura types.
  • The clinical significance of multiple auras in a single patient remains unclear.

Purpose of the Study:

  • To investigate the clinical and electrophysiologic features of patients reporting multiple aura types.

Main Methods:

  • Retrospective study of patients evaluated between 1989-2005.
  • Analysis of clinical data, electroencephalography (EEG), and ictal single-photon emission computed tomography (SPECT).

Main Results:

  • Thirty-one patients reported multiple aura types.
  • Most patients with multiple auras (90% with ≥2 types, 100% with ≥3 types) had seizures originating from the right/nondominant hemisphere.
  • Epilepsy surgery achieved seizure freedom in 53% of patients.

Conclusions:

  • Multiple aura types are associated with localized epilepsy in the nondominant hemisphere.
  • These patients are often suitable candidates for epilepsy surgery.
  • A potential mechanism involves restricted EEG seizure spread activating sequential zones without affecting consciousness.