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Olfactory epileptic auras

V Acharya1, J Acharya, H Lüders

  • 1Department of Neurology, The Cleveland Clinic Foundation, OH 44195, USA.

Neurology
|July 23, 1998
PubMed
Summary
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Olfactory epileptic auras, though rare, are not always unpleasant and often originate in the amygdala. Tumors are the most common cause, with surgical removal leading to seizure freedom in most cases.

Area of Science:

  • Neurology
  • Epileptology
  • Neuro-oncology

Background:

  • Olfactory epileptic auras are uncommon, representing 0.9% of all auras, and are typically perceived as unpleasant.
  • While historically linked to tumors, recent studies suggest other potential associations.

Purpose of the Study:

  • To investigate the characteristics and etiology of olfactory epileptic auras.
  • To determine the most likely origin and effective treatments for these seizures.

Main Methods:

  • Retrospective analysis of 13 patients with olfactory epileptic auras from 1423 partial epilepsy cases (1991-1996).
  • Utilized routine electroencephalograms (EEGs), magnetic resonance imaging (MRI), and prolonged video-EEG monitoring.
  • Assessed seizure evolution, EEG localization, and outcomes following surgical intervention.

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Main Results:

  • Olfactory auras varied in type and were unpleasant in only seven patients.
  • Auras frequently evolved into complex partial seizures, with some progressing to generalized tonic-clonic seizures.
  • EEG focus localized to the mesial temporal region in all patients, with mesial temporal tumors identified in ten.
  • Surgery resulted in seizure-free outcomes for eight of nine patients, including one requiring repeat surgery for residual tumor.

Conclusions:

  • Olfactory auras are not exclusively unpleasant.
  • The amygdala is identified as the primary symptomatogenic zone for olfactory auras.
  • Mesial temporal tumors are the predominant cause, while mesial temporal sclerosis is a less frequent etiology.