Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Data Supplement
Right arrow Correction (v69,p1890)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Widdess-Walsh, P.
Right arrow Articles by Burgess, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Widdess-Walsh, P.
Right arrow Articles by Burgess, R.
Related Collections
Right arrow Epilepsy monitoring
Right arrow Epilepsy semiology
Right arrow Intracranial electrodes
Right arrow Epilepsy surgery
Right arrow SPECT in epilepsy
NEUROLOGY 2007;69:755-761
© 2007 American Academy of Neurology

Multiple auras

Clinical significance and pathophysiology

P. Widdess-Walsh, MB, MRCPI, P. Kotagal, MD, L. Jeha, MD, G. Wu, MD and R. Burgess, MD, PhD

From the Cleveland Clinic Epilepsy Center (P.W.-W., P.K., L.J., R.B.) and Department of Nuclear Medicine (G.W.), Cleveland Clinic, OH.

Address correspondence and reprint requests to Dr. Prakash Kotagal, S51, Cleveland Clinic Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 kotagap{at}ccf.org

Background: Patients with partial epilepsy may report multiple types of aura during their seizures. The significance of the occurrence of multiple auras in the same patient is not known.

Methods: The clinical and electrophysiologic characteristics of patients with more than one aura type (abdominal, auditory, autonomic, gustatory, olfactory, psychic, somatosensory, and visual auras), evaluated in the Cleveland Clinic epilepsy monitoring unit between 1989 and 2005, were studied.

Results: Thirty-one patients experienced multiple aura types during a seizure. Ninety percent of patients with at least two aura types (n = 31) and 100% percent of patients with at least three aura types (n = 12) had seizures arising from the right/nondominant hemisphere. EEG seizures remained restricted in all patients during their auras. Twenty patients had epilepsy surgery with seizure freedom in 53%. Subdural EEG recordings in six patients showed either a march of sequential auras, or in one case, several ictal onset zones resulting in separate isolated auras. Ictal SPECT in six patients with right-sided seizures showed a lack of activation in brainstem structures.

Conclusions: Most patients who report multiple aura types have localized epilepsy in the nondominant hemisphere, and are good surgical candidates. A common mechanism for multiple auras may be a spreading but restricted EEG seizure activating sequential symptomatogenic zones, but without the ictal activation of deeper structures or contralateral spread to cause loss of awareness and amnesia for the auras.

Supplemental data at www.neurology.org

Disclosure: The authors report no conflicts of interest.

Received December 6, 2006. Accepted in final form March 19, 2007.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by AAN Enterprises, Inc.