What is meant by aura in epilepsy
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Aura in Epilepsy
Definition
An aura is a simple partial (focal) seizure that manifests as subjective sensory, autonomic, or psychic symptoms - without impairment of consciousness. It represents the initial phase of focal seizure activity, and in some instances may constitute the entire epileptic attack.
"An epileptic aura is a simple partial seizure manifesting as sensory, autonomic, or psychic symptoms."
- The Washington Manual of Medical Therapeutics
"An aura represents the initial phase of a focal seizure; in some instances, it may constitute the entire epileptic attack."
- Adams and Victor's Principles of Neurology, 12th Edition
Aura vs. Prodrome - An Important Distinction
These two terms are often confused:
| Feature | Aura | Prodrome |
|---|---|---|
| Nature | IS a seizure (focal ictal activity) | Pre-ictal feeling BEFORE the seizure begins |
| Duration | Seconds to a few minutes | Hours before the seizure |
| Consciousness | Preserved | Preserved |
| Examples | Rising epigastric sensation, deja vu | Irritability, depression, headache, malaise |
A prodrome is a vague feeling that a seizure will soon occur, while an aura is already part of the seizure itself.
Types of Auras and Their Localizing Value
Auras are extremely valuable clinically because they point to the location of the epileptogenic focus:
| Aura Type | Description | Localization |
|---|---|---|
| Somatosensory | Tingling, numbness, electric shock feeling in contralateral body | Contralateral posterior Rolandic (parietal) cortex |
| Visual | Unformed flashes, lights, patterns | Occipital cortex |
| Auditory | Buzzing, ringing, voices | Heschl gyri (superior temporal) |
| Olfactory | Strange, often unpleasant smell (uncinate fits) | Mesial temporal lobe / uncus |
| Gustatory | Unusual taste | Insula / fronto-parietal cortex |
| Vertiginous | Spinning sensation | Superior temporal cortex |
| Visceral / Autonomic | Rising epigastric sensation (most common), nausea, flushing, palpitations | Insular-orbital-frontal cortex |
| Psychic / Cognitive | Deja vu, jamais vu, dreamy states, depersonalization, fear, elation | Temporal lobe (amygdala-hippocampal complex) |
The rising epigastric sensation is the most common aura and is a hallmark of temporal lobe epilepsy (TLE).
Clinical Significance
- Localizing value: The type of aura helps identify the seizure onset zone. This is critical for epilepsy surgery workup.
- Warning function: The aura gives the patient a few seconds to minutes of warning before a full seizure, allowing them to move to safety, sit down, or alert someone nearby.
- Diagnostic clue: Recurrent stereotyped auras without witnessed generalization can be the only manifestation of focal epilepsy, and are frequently underdiagnosed.
- Consciousness is preserved: Because it is a simple partial seizure, the patient remains alert and can recall the aura - distinguishing it from complex partial seizures and generalized seizures.
- Treatment implications: Knowing the aura type guides medication choice and surgical planning.
Relationship to Seizure Progression
Prodrome (hours before) → Aura (focal simple partial seizure) → Complex partial seizure (focal with impaired awareness) → Secondary generalization (tonic-clonic)
Not all seizures follow this full progression. Some patients experience only an aura; others progress directly to generalized convulsions without a prior aura (as is typical in primary generalized tonic-clonic seizures, where there is generally NO aura).
Sources:
- Adams and Victor's Principles of Neurology, 12th Ed. - Classification of Seizures chapter
- The Washington Manual of Medical Therapeutics - Seizures chapter (Definition section)
- Tintinalli's Emergency Medicine - Signs and Symptoms Associated With Seizures
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