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Epileptic olfactory auras: a clinical spectrum.

İrem Taşcı1, Ferhat Balgetir2, Bülent Müngen3

  • 1Malatya Teaching and Research Hospital, Neurology Clinic, Malatya, Turkey.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|January 11, 2021
PubMed
Summary

Olfactory auras (OAs) occur in 5.1% of focal epilepsy patients, often manifesting as elementary, unpleasant, or neutral sensations. These auras are frequently linked to the temporal lobe, with no hemispheric preference observed.

Keywords:
AuraClinical spectrumEpilepsyOlfactory

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Area of Science:

  • Neurology
  • Epileptology
  • Clinical Neuroscience

Background:

  • Olfactory auras (OAs) are a recognized but infrequently studied symptom in focal epilepsy.
  • Understanding the prevalence and characteristics of OAs is crucial for accurate localization of the epileptogenic zone.

Purpose of the Study:

  • To determine the relative frequency of OAs in a large cohort of focal epilepsy patients.
  • To characterize the clinical spectrum of OAs, including their relationship to hemispheric lateralization and the localization of the epileptogenic focus.

Main Methods:

  • Retrospective analysis of medical records from 1384 patients with focal epilepsy.
  • Identification of 71 patients (5.1%) experiencing OAs.
  • Classification of OAs based on clinical features and correlation with electroencephalography (EEG) and magnetic resonance imaging (MRI) findings.

Main Results:

  • OAs were present in 5.1% of focal epilepsy patients.
  • The clinical spectrum included complex and elementary OAs, with elementary OAs being more common.
  • Elementary OAs were further categorized into neutral, unpleasant, and pleasant types, with pleasant OAs being rare.
  • No significant difference in hemispheric lateralization of the epileptogenic focus was observed.
  • The temporal lobe was the most common site for the epileptogenic zone (81.7% of cases).

Conclusions:

  • The prevalence of OAs in focal epilepsy may be higher than previously estimated.
  • Elementary OAs are more frequent than complex OAs.
  • Unpleasant and neutral elementary OAs are the most common subtypes, while pleasant OAs are rare.
  • OAs can provide valuable clinical clues for localizing the epileptogenic zone, particularly within the temporal lobe.