Auras are frequent in idiopathic generalized epilepsy

Abstract

The occurrence of an aura is often considered evidence of a partial rather than an idiopathic generalized epilepsy syndrome. The authors examined this hypothesis by prospectively recording reports of auras by patients being admitted for video-EEG monitoring. Auras were equally common (70%) among patients with idiopathic generalized epilepsy as they were among those with localization-related epilepsy. Presence of an aura is not a reliable indicator of localization-related epilepsy.

Auras in generalized epilepsy

“…4 Auras were reported in 13% of subjects with GE in a large study evaluating 3 population-based twin registries. 6 Another study found sensory, psychic, and autonomic auras reported by 20 of 37 patients (54%) with JME.…”

“…However, prior research questions the validity of this conventional interpretation. [4][5][6] Distinguishing focal epilepsy (FE) and generalized epilepsy (GE) syndromes typically occurs early in a patient's diagnostic evaluation and significantly affects therapeutic decisions. We used a semistructured interview to obtain information about auras in a large cohort of patients with GE.…”

“…4,[15][16][17][18][19] Focal clinical features such as forced lateralized head turning at seizure onset, and asymmetries and asynchronies of limb movements during the clonic phase also occur in IGE. 15 In patients with JME, unilateral and asymmetric myoclonic jerks can occur.…”

“…26 Auras and other "focal" features in patients with GE can lead to the misdiagnosis of FE. 4,5,16,18,19,26 It is also possible that auras in GE are underreported, and may be more likely to be elicited with systematic questioning. For most patients with epilepsy, an initial goal of clinical evaluation is distinguishing GE from FE.…”

Seizure Semiology: An Overview of the ‘Inverse Problem’

“…Recently, asymmetric termination of the tonic phase has also been described in about 20% of primarily generalized seizures [38]. It has also been reported that patients with IGE may mention auras in the seconds or minutes before a seizure, with a prevalence (up to 70%) similar to that of subjects suffering from localization-related epilepsy [74]; as compared with the latter, patients with IGE tend to perceive their warnings in the midline of the body and to have a less discriminatory (precise) anatomical character. Visual auras are also described, and they tend to occur as very brief flashing sensations [75].…”