Common Aura Research Articles

Headache Is a Common Aura in Patients with Generalized Seizures.

Although aura in epilepsy is usually considered as a phenomenon in patients with focal seizures, headache can occur as an aura or solitary epileptic symptom in patients with generalized seizures. We performed a 14-year retrospective study of patients with generalized seizures and analyzed the proportion and characteristics of patients with auras including headache. Among the 102 patients diagnosed with generalized seizures, aura was reported in 45 patients and headache was the most common aura in 26 patients. The age of onset of seizures was significantly lower in patients with headache as an aura than in patients without headache (14.8±3.8 vs. 24.7±16.2; p=0.003). Our study showed that headache was the most common aura in patients with generalized seizures and patients with a younger age of onset of seizures were more likely to experience headache as an aura in these patients.

Study on "Atypical" Migraine Auras in the Pediatric Age: The Role of Cortical Spreading Depression and the Physiopathogenetic Hypothesis Arising from Our Clinical Cases.

Migraine is a complex neurologic disorder by which several systems of the central nervous system (autonomous system, affective, cognitive, sensory and motor system) may be affected on different levels. About a fourth of migraine patients have migraine auras. The most common aura is the visual aura followed by the sensorial aura but motor deficits, as well as deficits of higher cortical centers (disorders of thinking, orientation, coherence, or concentration), may occur as well. In analogy with a headache diary, an aura diary can deliver important help in the diagnostic process of rare migraine manifestations and prevent the under-diagnosis of unusual migraine manifestations. Complex migraine manifestations are a diagnosis of exclusion, and a broad diagnostic work-up is necessary in order to exclude dangerous neurologic pathologies. In addition, here, we discuss the atypical clinical presentation and possible physio-pathogenetic related aspects of these atypical migraine aura features in the developmental age. In addition, we wanted to stress and analyze the clinical aspects of our children/adolescents with atypical auras, which seem to be more difficult to frame with the mechanisms originally proposed to explain the physio-pathogenetic relationship between CSD and aura. Finally, we discuss in detail the complex aspects of this topic on the basis of available data and propose new terminology: “Multiple, Synchronous and Asynchronous, Cortical and Subcortical Spreading Depression”.

Migraine pathophysiology, clinical correlates

Migraine is well known by the headache itself, however there are many other signals and symptoms that can occur during an attack. Some symptoms, called premonitory symptoms, such as yawning and feeling tired, occur in 72–84% of patients. About 20% of migraineurs present aura. The most common aura is visual disturbances, following by sensitive symptoms. The headache of migraine is characterized by pulsatile unilateral pain, of moderate to severe intensity, that worsen by routine physical activities, associated with photo/phonofobia, nausea and vomiting. About 68–80% of migraine patients present the last phase called postdrome or resolution, in which the most common symptoms are tiredness and cognitive difficulties. This lecture will discuss the pathophysiological aspects of the main signals and symptoms of a migraine attack.

Clinical characteristics of migraine: A prospective cross-sectional study over nine years

Background: Migraine is the most common primary headache. This study aimed to describe clinical observations about migraine in outpatients in Iraq, including migraine types and subtypes, duration and frequency of acute attacks, severity, disability, effects on the quality of life, and complications. Methods: This is an outpatient-based prospective cross-sectional study, conducted in the Misan province, Iraq over nine years, and included 1412 patients aged 12 to 50 years. The data was collected from clinical records of patients who attended outpatient clinics. Results: The study included 1100 women (77.9%) and 312 men (22.1%); the women/men ratio being 3.5:1. The median age and standard deviation (SD) was 21 ± 5.42 years. The mean age at first attack of migraine was 17 ± 4.91 years. Migraine without aura was the most common type, accounting for 68% of the cases. The mean frequency of the attacks was (2 ± 4.63) days/month. In general, acute attacks were moderate to severe. Conclusions: In our study, we observed that migraine causes a headache resulting in episodes of temporary functional disability and women suffered more than men (ratio of 3.5:1). The mean age at first attack was a young age, and a family history of migraine highly altered distribution. Migraine without aura was the most common type, and symptoms including nausea and vomiting and photophobia were experienced by patients, which were used to diagnose migraines. Experienced aura was the most common migraine with aura, but also aura without a headache and aura with migraine were prevalent; therefore, it is important to differentiate between migraine subtypes. Visual aura was the most common aura, while motor symptoms were very rare. Chronic persistent headaches were a common complication recorded. These features provide evidence for the creation of screening tools in migraine prevention migraine.

T05. Pre-surgical assessment of drug-resistant insular and peri insular epilepsy: A single center experience

Epilepsy arising from the insula is widely regarded as a challenging type of seizure, probably owing to the deep-seated location of the insula and the extensive connections it makes with adjacent structures. In recent years, we have rapidly gained insights into insular epilepsy-related obstacles. Here, we describe a detailed analysis of the electro-clinical manifestations of this type of epilepsy using intra-cerebral recordings performed with Stereo-electroencephalography (SEEG). We retrospectively analyzed 12 patients from our epilepsy program who underwent insular exploration using SEEG between June 2013 and June 2017. Patient information reviewed included demographics, clinical history, neurological examination; neuroimaging studies (Brain MRI, PET, Ictal SPECT), Scalp video-EEG, intracranial recordings with SEEG, histopathological findings, and surgical outcomes. 12 patients (M:F = 4:8; mean age, 32.5 years; range, 19–60 years) were found with seizures originating from either the insula alone or simultaneously originating from the insula and adjacent structures. One patient had a family history of epilepsy and another one had previous exposure to viral meningoencephalitis. Six patients had undergone prior surgery for epilepsy treatment. The mean seizure frequency was 4 seizures per week, and one patient experienced seizures daily. The most common aura was somatosensory sensation, followed by cephalic sensation in 4 and 3 patients, respectively. The commonest type of seizure was focal with impaired awareness in 10 patients. 50% of the patients showed a tendency for secondary generalizations, and 25% showed nocturnal predominance. Lesions were observed on brain MRI in 8 cases. Scalp EEG revealed different interictal discharge distributions: 5 patients showed localized frontotemporal spikes, 3 showed bilateral temporal spikes, and no spikes were detected in 4. The location of ictal onset could be localized in only 50% of patients. The most common scalp EEG ictal pattern was rhythmic delta activity (1–3 Hz). Subsequent SEEG showed six patients found to have a combination of clinical and subclinical seizures. SEEG clinical seizure onset from the insula alone was found in 50% of the patients (3 right, 2 left, 1 bilateral). The other patients presented with simultaneous onset from the insula and adjacent structures: 4 from mesial temporal structures, 1 temporal operculum, and 1 frontal operculum. The commonest SEEG ictal pattern was low voltage fast activity in 8 patients. Surgical resections guided by SEEG findings were performed in 5 patients and led to excellent outcomes; all these cases had Engle class 1 outcome at 6–24 months follow up. We observed that it is not uncommon for seizures to simultaneously originate from the insula and adjacent structures. However, non-invasive EEG monitoring tools are likely insufficient to detect such simultaneous seizures. For the given sample, SEEG proved beneficial in providing optimal surgical outcomes.

Incidence and localizing value of vertigo and dizziness in patients with epilepsy: Video-EEG monitoring study

Vertigo and dizziness are common neurological complaints that have long been associated with epilepsy. However, studies of patients with epileptic vertigo or dizziness with concurrent EEG monitoring are scarce. We performed the present study to investigate the incidence and localizing value of vertigo and dizziness in patients with epilepsy who had confirmation of EEG changes via video-EEG monitoring. Data of aura and clinical seizure episodes of 831 consecutive patients who underwent video-EEG monitoring were analyzed retrospectively. Out of 831 patients, 40 patients (4.8%) experienced vertigo or dizziness as aura (mean age, 32.8±11.8years), all of whom had partial seizures. Eight had mesial temporal, 20 had lateral temporal, four had frontal, one had parietal, and seven had occipital lobe onset seizures. An intracranial EEG with cortical stimulation study was performed in seven patients, and the area of stimulation-induced vertigo or dizziness coincided with the ictal onset area in only one patient. Our study showed that vertigo or dizziness is a common aura in patients with epilepsy, and that the temporal lobe is the most frequent ictal onset area in these patients. However, it can be suggested that the symptomatogenic area in patients with epileptic vertigo and dizziness may not coincide with the ictal onset area.

Unusual Migraine Manifestations

Migraine is a complex neurologic disorder by which several systems of the central nervous system (autonomous system, affective, cognitive, sensoric and motoric system) may be affected on different levels. Around a fourth of the patients have migraine aura. The most common aura is the visual aura, followed by sensoric aura. But motoric deficits as well as deficits of higher cortical centers (disorders of thinking, orientation, coherence or concentration) may occur as well. In analogy with a headache calendar, an aura calendar can deliver important help in the diagnostic process of rare migraine manifestations and prevent underdiagnosis of unusual migraine manifestations. Complex migraine manifestations are diagnoses of exlusion, and a broad diagnostic work-up is warranted in order to exclude dangerous neurologic pathologies. There are no specific therapeutic recommendations, as there is a lack of randomized controlled studies.

Clinico-electroencephalography pattern and determinant of 2-year seizure control in pati186tern Nigeria

Background:Complex partial seizures (CPS) may present with milder symptoms mimicking normal function of an adult person making the diagnosis delayed or often missed. There is a need for an in-depth training in epileptology to understand the various pattern of electro-clinical presentation of CPS. Ability to predict seizure control on first diagnosis can be very useful in the management of patients with CPS. However, there is a paucity of data on CPS in North-western Nigeria.Aim:This study aimed to describe the clinical and EEG characteristics of CPS and evaluate independent determinant of 2-year seizure control among adults with partial epilepsy in Kano, North-western Nigeria.Subjects and Methods:Out of all patients diagnosed with epilepsy (PWE) at the adult neurology clinic of two tertiary hospitals in Kano over a period of 4½ years, those with CPS were prospectively studied. Diagnosis of CPS was based on both clinical and EEG findings. Patients were followed-up for a minimum period of 2-year to determine their seizure control status. Data were analyzed using STATA version 10.Results:Total of 158 (105 males, 53 females) were enrolled. Their age ranged between 15 and 85 (median = 30.5) years. Sixty six (66/158,41.7%) had aura and 64 of them (64/158, 41.1%) had automatism. The most common aura and automatism were abnormal epigastric sensation and oro-alimentary respectively. Twenty eight (28/158, 18%) had associated behavioral manifestations. EEG abnormality was recorded in 56 (56/158, 53.9%). Adequate seizure control was achieved in 55% (70/128) on anti-epileptic drugs (AEDs). Duration of epilepsy, before the commencement of AEDs was identified as an independent determinant of 2-year seizure control.Conclusion:Abnormal epigastric sensation and oroalimentary automatism were the most common clinical complaint. Duration epilepsy over 3 years or less was identified as an independent predictor of 2-year seizure control.

Status Epilepticus Amauroticus and Posterior Reversible Encephalopathy Syndrome in Children

Transient cortical visual impairment is a common aura of occipital lobe seizures. However, status amauroticus for hours has rarely been described as a manifestation of occipital lobe status epilepticus. To describe status amauroticus caused by focal status epilepticus of occipital lobe origin in two children with MRI findings consistent with posterior reversible encephalopathy syndrome. Retrospective review of clinical records of two children who developed status amauroticus in association with posterior reversible encephalopathy syndrome, identified through the EEG database at British Columbia Children's Hospital. Case 1: A 15-year-old boy with chronic renal failure on hemodialysis developed acute headache, hypertension, vomiting, and blurred vision followed by severe visual impairment and a secondarily generalized clonic seizure. EEG demonstrated independent right and left occipital seizures. After phenytoin therapy, visual acuity was 20/20 within 48 hours. Case 2: A 10-year-old girl with beta-thalassemia treated with allogenic bone marrow transplantation developed acute headache, hypertension, severe visual impairment (light perception), encephalopathy, and intermittent dysconjugate gaze. EEG showed status epilepticus of biposterior quadrant origin. After phenytoin treatment, vision normalized within 72 hours. Reversible status amauroticus because of occipital lobe status epilepticus may be the presenting symptom of posterior reversible encephalopathy syndrome and EEG recording should be performed.

The influence of Roger Corman in Richard Corben’s The Fall of the House of Usher

Abstract This article presents a comparative analysis of the movie (directed by Roger Corman in 1960) and the comic-book version (drawn by Richard Corben in 1989 for Pacific Comics) of Edgar Allan Poe’s The Fall of the House of Usher. Both adaptations can be considered unfaithful to the original tale. However, as M. L. Rosenblat affirms in his book about Poe and Cortazar, the originality of Poe is related to the creation of a new effect. This article studies how this effect is represented visually in Corman’s work and how Corben uses some of the same visual ideas to revive this effect. Corman’s work attempts to identify a relationship between Poe and Freud, affirming that they have the same concept of the unconscious. The difference between the conscious and the unconscious is shown by Corman in the opposition between the narrator of the story and the character of Roderick Usher as the director plays with the concept of on-camera (for the conscious) and off-camera (for the unconscious). The same idea is captured by Corben when he attempts to show this opposition between the two characters, including the physical resemblance of the narrator with Poe himself. This opposition between the conscious and the unconscious plays a crucial role in the way Corman develops the movie’s scenarios (with two levels representing different states of mind) and places the camera. This article shows how Corben includes his own contributions but follows the principles introduced by Corman to create an oppressive atmosphere that reflects the effect created by Poe’s tales. Other aspects examined in this article include the use of colour in both works to represent the melancholy, following the ideas presented by Yves Hersant in his essay about the colours of the melancholy, and the representation of the incestuous relationship between Roderick and Madeleine, which is similar in both works in the understanding of incest as an element of the American Gothic, as defined by Leslie Fiedler. Considering these aspects and following the idea presented by Linda Hutcheon in her book A Theory of Adaptation (2006), it can be affirmed that these adaptations share what can be called, in Benjaminian terms, a common aura.

Characteristics of auras in patients undergoing temporal lobectomy

Prior studies suggest that aura semiology may have localizing value. However, temporal lobe aura characteristics and response to surgery have not been studied in large patient series. The authors retrospectively analyzed the case records of 182 patients undergoing temporal lobectomy for medically intractable epilepsy at a single institution. They analyzed the frequency and type of auras and seizures preoperatively, and at 3 months and 1 year after temporal lobectomy. Auras were divided into medial semiology (rising epigastric, olfactory/gustatory, experiential, and fear) and lateral semiology (auditory, somatosensory, and visual), or other. Of 182 patients, 150 were included in this study. The preoperative prevalence of auras was 77%. Multiple types of auras were present in 20% of patients. The most common aura was rising epigastric (26% of all auras). Postoperatively, auras were eliminated in 63% of patients at 3 months and in 64% at 1 year. Seventy-seven patients (51%) were seizure-free and aura-free, 22 (15%) were seizure-free with auras, 26 (17%) had seizures but no auras, and 25 (17%) had seizures with auras. Despite having their auras eliminated, 6.7% of patients continued to have complex partial seizures. Lateral temporal auras were more than twice as likely as medial temporal auras to persist after surgery (p < 0.002). While the majority of patients in the authors' series became seizure- and aura-free, a significant minority still had persistent auras. Patients with lateral temporal auras appear to be at increased risk for having persistent postoperative auras. The discrepancy between aura and seizure outcomes results in a small group of patients having persistent seizures but losing their auras postoperatively.

Hungarian migraine epidemiology.

A population-based epidemiological survey of migraine without aura and migraine with aura completed by mailed questionnaire in Hungary. The diagnosis and classification of migraine was according to the criteria of the International Headache Society. The validity of the self-administered headache questionnaire was evaluated by a neurologist using clinical interviews. The study population was a random sample of 2000 men and women aged between 15 and 80 years. The questionnaire was completed by 813 of 1910 people (392 men and 421 women), providing a 42.6% participation rate. Sixty-seven percent of these people experienced some kind of headache during their lives. The 1-year prevalence of migraine without aura was 7.6% (the female/male ratio was 3:1), while the 1-year prevalence of migraine with aura was 2% (female/male ratio was 2:1). Most migraineurs experienced headache attacks 1 to 4 times monthly, which lasted 24 hours. The most characteristic accompanying signs were nausea and phonophobia. Stress, sleep deprivation, hot weather, and fasting were the most common precipitating factors of a migraine attack. In the migraine with aura group, the most common aura was a visual disturbance. Only 43% of migraineurs had ever consulted a physician for headache, and only 15% of patients had missed work or school because of a migraine attack in the previous year. Most of the patients suffering from migraine without aura were between 20 and 40 years old, while migraineurs with aura were over 40 years old. According to this investigation, the prevalence of migraine was not lower than in Western countries.

Epidemiologic and clinical characteristics of migraine and tension-type headache in Korea.

This is the first population-based epidemiologic study of chronic headache in South Korea. The diagnosis and classification of headache was according to the criteria of the International Headache Society. Sixty-eight percent of the studied population experienced headache during the preceding year. The estimated prevalences were 22.3% for migraine (male 20.2%, female 24.3%) and 16.2% for tension-type headache (male 17.8%, female 14.7%). In migraine, the 15- to 19-year age group showed maximal prevalence in both sexes (male 28.5%, female 34.7%). The prevalence of tension-type headache was highest in the 50- to 59-year age group in men (24.2%) and in the 20- to 29-year age group in women (20.2%). In migraine, headache intensity was more severe in women than in men, but in tension-type headache there was no difference in the severity of headache between the sexes. Phonophobia was the most common associated symptom of migraine (65.1%). In the migraine with aura group, the most common aura was visual disturbance, including scintillation and image distortion (82.3%). Only 24.4% of migraineurs and 12.3% of patients with tension-type headache had ever consulted a doctor for headache. The prevalence of migraine was not lower than in western countries and much higher than in previous studies conducted in other Asian countries.