Epileptic Aura Research Articles

Differential diagnosis of visual aura in migraine and epilepsy

Visual phenomena like lightnings, disturbed contours of objects, or skotoma, can be due to ophthalmological diseases, but can also occur as symptoms generated by the central nervous system ("aura") in migraine or epilepsy. A subsequent hemicrania is considered as a hallmark of migraine, but in many cases does not allow for a certain distinction from postictal headaches in patients with focal epilepsy. A detailed analysis of the aura does, however, provide sufficient information for classifying the disorder as an aura in migraine or as a simple partial epileptic seizure in most cases. The higher degree of differentiation of visual phenomena including colour, movement, and complex visual phenomena, is characteristic of the activation of neuronal circuits during an epileptic aura. The higher speed of transsynaptic propagation of epileptic discharges and postictal inactivation causes a more rapid time-course of the epileptic aura as compared to a migraine aura resulting from a depolarization spreading by diffusion. Clinically, the diagnosis of epilepsy is supported by additional positive motor phenomena or by a transition into a complex partial seizure, e. g. when epileptic activity spreads into a temporal lobe. Secondarily generalized seizures, however, may also occur in patients with migraine. Interictal and ictal EEG recordings can be important to prove an epileptic origin, but their sensitivity is low if ictal discharges remain limited to a small brain area. In rare cases, measurements of ictal cerebral perfusion can contribute to the differential diagnosis.

Painful Auras in Focal Epilepsy

The localizing and lateralizing value of painful epileptic auras in 25 patients with focal epilepsy were studied at the Cleveland Clinic, OH.

Painful auras in focal epilepsy.

The authors studied the localizing or lateralizing value of painful epileptic auras in 25 patients with focal epilepsy. Painful auras were seen in 4.1% patients with focal epilepsy arising from temporal, frontal, perirolandic, or parieto-occipital regions. Abdominal pain was present in 5% of all abdominal auras in temporal lobe epilepsy and 50% of all abdominal auras in frontal lobe epilepsy. In perirolandic epilepsy, painful somatosensory auras were lateralized contralateral to the epileptic hemisphere but not consistently in temporal lobe epilepsy.

Clinical Study on Epileptic Aura in Children with Temporal Lobe Epilepsy

Clinical Study on Epileptic Aura in Children with Temporal Lobe Epilepsy

Epilepsia do lobo temporal com aura de prazer: relato de caso

We report on a woman with temporal lobe epilepsy and "orgasm sensation" like an epileptic aura. Literature is controversial about pleasure and ecstasy as an epileptic aura. Aura of pleasure in this case is confirmed, by clinical investigation, electroencephalogram and seizures remission with treatment (phenytoin).

Personality disorders among medically refractory epileptic patients.

DSM-III-R personality disorders were assessed in 52 medically refractory epileptic patients. Twenty-one percent of patients met threshold criteria for an Axis II disorder. Dependent and avoidant personality disorders were the most common diagnoses. Epileptic aura was positively correlated with the presence of personality disorders. These results support previous studies that have demonstrated an increased rate of dependency and social isolation in epileptic patients. This increase may be related to disrupted psychosocial functioning as a consequence of having epilepsy, to disrupted neuronal function in central nervous system structures as a consequence of repeated epileptiform discharge or to some combination of the two.

Olfactory epileptic auras.

Olfactory epileptic auras are rare, constituting about 0.9% of all auras, and are typically described as unpleasant. They have usually been associated with tumors, but in some recent studies they have not. We identified 13 patients (7 male, 6 female) with olfactory epileptic auras from 1423 patients with partial epilepsy evaluated for intractable seizures between 1991 and 1996. All had routine EEGs and MRI. Twelve underwent prolonged video-EEG monitoring. Olfactory sensations were of various types but unpleasant in only seven. Auras evolved to complex partial seizures (automotor, hypermotor, or dialeptic seizures) in 12 patients, with further evolution to generalized tonic-clonic seizures in three and aphasic seizures in one patient. The EEG focus was localized to the mesial temporal region in all. Ten patients had a mesial temporal tumor; in one patient, it extended to the superior temporal gyrus, and in another, the frontal lobe. The tumor involved only the amygdala in two patients and both amygdala and hippocampus in six; none had hippocampal involvement alone. Surgery was performed in nine patients. All except one with partial tumor resection had a seizure-free outcome. This patient also became seizure-free after repeat surgery to remove residual tumor tissue in the amygdala. Olfactory auras are not necessarily unpleasant. The amygdala is the most likely symptomatogenic zone of olfactory auras. Tumors are the commonest etiology; mesial temporal sclerosis is a relatively rare cause.

Aura phenomena during syncope.

We studied the frequency and clinical characteristics of aura phenomena in 60 patients with cardiac and 40 subjects with vasovagal syncopes. The majority (93%) of all syncope patients recalled having experienced an aura. Aura phenomena were similar in both groups and were mostly compound auras comprising epigastric, vertiginous, visual, or somatosensory experiences, but were more detailed in the noncardiac group. The localizing significance of auras preceding a syncope was generally poor. Although hard to distinguish from epileptic auras from their structure and shape, syncope-related auras lacked symptoms that are commonly reported after epileptic seizures such as tastes, smells, déjà vu phenomena, scenic visual perceptions, and speech impairments. A detailed anamnestic exploration of auras seems worthwhile in unexplained disorders of consciousness.

The relationship of epileptic auras and psychological attributes

Studies suggest a high frequency of epileptic auras with intellectual content among epileptic patients with psychopathology and personality disorders. This study compared measures of personality and psychosocial functioning between epileptic patients with cognitive auras and epileptic patients with noncognitive auras. Ten patients with complex partial seizures who experienced cognitive auras had consistently more depressive traits and psychosocial difficulties than 50 patients with other psychic or nonpsychic auras, particularly if the patients with cognitive auras had left hemisphere epileptiform foci. Cognitive auras may be associated with depressive traits among epileptic patients. The findings were also in agreement with studies that relate the left hemisphere to depression.

The anatomy of epileptic auras: focal pathology and surgical outcome

An aura is generally understood to be the beginning of a seizure. Yet, following successful surgery for intractable epilepsy, patients may have persistent auras even though they are otherwise seizure free. Ninety patients with intractable seizures and auras underwent resective surgery. Forty-three patients had hippocampal sclerosis and 47 had temporal or extratemporal lesions such as glial tumors or vascular malformations. The semiology of the auras was found to have value in localization but not lateralization of the pathology. Epigastric auras as well as gustatory and olfactory auras were significantly more frequent in patients with hippocampal sclerosis than in those with temporal or extratemporal lesions. Auras of vertigo or dizziness were most frequent in patients with extratemporal pathology. There was a significant difference between the pathology groups in the efficacy of resection in eliminating the auras. Of the patients with hippocampal sclerosis who were rendered seizure free, 18.9% had persistent auras, whereas only one (2.6%) of the patients with temporal or extratemporal lesions who were rendered seizure free had persistent auras. These findings suggest that for patients with hippocampal sclerosis an anatomical dissociation between seizure and aura may occur, whereas this dissociation is not present in patients with lesions. Patients suspected of having hippocampal sclerosis should be counseled preoperatively as to the significant likelihood of persistent auras even if seizures are successfully abolished.

Relationship of seizure variables to personality disorders in epilepsy.

Among epileptic patients, personality disorders may be associated with specific seizure manifestations. In an epilepsy clinic, we identified 42 idiopathic epilepsy patients diagnosed with various DSM-III-R personality disorders, including borderline, atypical or mixed, explosive, and dependent. When compared with 42 age- and sex-matched epileptic control subjects on six seizure variables, the personality disorder group had more patients with epileptic auras (P = 0.001), particularly "cephalic" auras, and fewer with secondarily generalized tonic-clonic seizures (P < 0.05). These findings suggest that the experience of epileptic auras contributes to the development of personality disorders, especially when auras are not masked by secondarily generalized seizures.

Joan of Arc

For centuries, romantics have praised and historians and scientists debated the mystery of Joan of Arc's exceptional achievements. How could an uneducated farmer's daughter, raised in harsh isolation in a remote village in medieval France, have found the strength and resolution to alter the course of history? Hypotheses have ranged from miraculous intervention to creative psychopathy. We suggest, based on her own words and the contemporary descriptions of observers, that the source of her visions and convictions was in part ecstatic epileptic auras and that she joins the host of creative religious thinkers suspected or known to have epilepsy, from St. Paul and Mohammed to Dostoevsky, who have changed western civilization.

Sudden religious conversions in temporal lobe epilepsy.

The ‘religiosity’ of the epileptic has been recognized since the time of Esquirol (1838) and Morel (1860). These, and later French workers (including Marchand and Ajuriaguerra, 1948), have sought to explain the epileptic's religiosity as being the result of his disability, social isolation and his enhanced need for the consolation of religion. A specific conversion experience after a fit was reported by Howden (1872–73). The patient believed that he was in Heaven. He would appear to have been depersonalized, as it took three days for his body to be reunited with his soul. ‘He maintained that God had sent it to him as a means of conversion, that he was now a new man, and had never before known what true peace was…. He assured me that he was a converted man and that he was convinced he would have no more fits.’ Howden also reported on John Engellerecht who, after many years of depression, attempted suicide and appeared to die. After visiting Hell and Heaven, he cast off his depression, and acquired a state of religious ecstasy accompanied by visual and auditory hallucinations. Boven (1919) mentions a 14-year-old boy who after a seizure ‘saw the good God and the angels, and heard a celestial fanfare of music’. He regards the religiosity of the epileptic character as being due to experiences acquired in the course of an epileptic aura and in the subsequent confusional state. Eventually the patient becomes preoccupied with a cure which he believes depends entirely on God, and this belief is the basis of his euphoria. Boven stresses the intensified piety of the epileptic after a severe seizure.

Blocking of Petit‐mal Attacks by Sensory Arousal and Inhibition of Attacks by an Active Change in Attention during the Epileptic Aura*

SUMMARYThe blocking effect of sensory arousal and of active attention on epileptic seizures is studied in 200 cases of petit‐mal and 20 cases of grand mal with focal onset. The mechanisms of the seizure block may be similar to desynchronization and reciprocal inhibition of neuronal activity in the cortex during arousal. They may arise from the non‐specific thalamo‐reticular system which is activated by sensory afferents or attention.RÉSUMÉL'effet du blocage d'une excitation sensorielle et de l'attention active dans des crises épileptiques a été observé en 200 cas de petit mal et 20 cas de grand mal ayant eu un début focal. Les mécanismes du blocage pendant la crise peuvent être semblables à une désynchronisation et à une inhibition réciproque de l'activité neuronale dans le cortex durant l'excitation. lis peuvent provenir du système thalamo‐réticulaire non spécifique qui est activé par des afférents sensoriels ou par l'attention.

Ictal emotions occurring in temporal lobe dysfunction.

As early as 1879 Jackson 1,2 described the feelings of fear associated with an epigastric aura. He felt that this emotion was an integrated part of an epileptic attack. Only during the past 20 years have neurologists and some psychiatrists paid further attention to certain emotional phenomena which may occur during an epileptic aura or (in combination with motor and/or sensory manifestations) during an epileptic discharge. Emotional phenomena may even be experienced as the only manifestations of clinical or subclinical epileptic seizures, or they may occur as a result of after-discharges following manifest seizures. Penfield and Jasper 3 have pointed out that patients afflicted with temporal lobe epilepsy are prone to experience emotions. authors even evoked emotional reactions, such as feelings of fear, fright, and terror—unrelated to environmental factors—by electrical stimulation of certain temporal lobe areas. These emotions of fear are not simple fear that an attack is about

Causalgic Pain as an Epileptic Aura1

Causalgic Pain as an Epileptic Aura¹

HALLUCINATIONS OF REMEMBERED SCENES AS AN EPILEPTIC AURA

Journal Article HALLUCINATIONS OF REMEMBERED SCENES AS AN EPILEPTIC AURA Get access P. K. ROBINSON, P. K. ROBINSON Search for other works by this author on: Oxford Academic PubMed Google Scholar A. C. WATT A. C. WATT Search for other works by this author on: Oxford Academic PubMed Google Scholar Brain, Volume 70, Issue 4, December 1947, Pages 440–448, https://doi.org/10.1093/brain/70.4.440 Published: 01 December 1947

The Adlerian approach to a case of idiopathic epilepsy

A case of idiopathic epilepsy has been presented from the point of view of the Adlerian or inferiority school. The patient’s personality goal (method of warding off inferiority feelings) was isolated. The patient’s emotional history was presented in sufficient detail to indicate that reality defeated the goal, that the patient fled into his psychosis to create an imaginary world in which the goal was realized. Evidence was presented to show the inferiority motivation of epileptic auras, seizures, equivalents, postconvulsvie confusion and interparoxysmal personality.

The `Dreamy State' as an Epileptic Aura, with Remarks on the Occurrence of Elaborate Mental States at the Beginning of Epileptic Fits

The `Dreamy State' as an Epileptic Aura, with Remarks on the Occurrence of Elaborate Mental States at the Beginning of Epileptic Fits

VERTIGO DUE TO INTRACRANIAL DISEASE

There is no symptom more difficult to define on the part of the patient than vertigo, because this term is used to describe the slightest giddiness, falling sensation, epileptic aura or fainting spell. Vertigo has been described as a feeling of discomfort arising from a disturbance of the relations of the body to space or a feeling of loss of balance. One of the best descriptions is by Hughlings Jackson, who described vertigo as a sensation of motor origin the result of a discord between the impressions which come from the labyrinth, the cerebellum, eye muscles and from other sources with which they coordinate or act in harmony. As the result of the discord of these impressions, consciousness is affected with a distressing sensation known as vertigo. Jackson rightly emphasized that this sensation is perceived through the cerebral hemispheres. It would be important if it were possible to differentiate organic