Epileptic Disorders


The localizing value of epileptic auras: pitfalls in semiology and involved networks Volume 21, numéro 6, December 2019

Figure 1

Localization of auras to seizure onset zone. Olfactory, fear, epigastric, psychic and autonomic auras predominantly localize (≥ 70%) to the mesial temporal region. Similarly, gustatory auras and visual illusions commonly originate from lateral temporal (70%) and occipital cortex (60%), respectively. Remaining auras (simple hallucination, ictal blurring, complex visual hallucination, vestibular, auditory and somatosensory auras) have variable distribution and have poor localizing value (≤ 50%).

() – number of patients with auras;

μ - Acharya et al., 1998; € - Bien et al., 2000; ¶ - Chen et al., 2003; * - Clarke et al., 2003; # - Fish et al., 1993; £ - Fornazzari et al., 1992; § - Hausser-Hauw and Bancaud, 1987; ¥ - La Vega-Talbot et al., 2006; ¢ - Pugnaghi et al., 2011; ∫ - Russo et al., 2016; ± - Ye et al., 2012.

Figure 2

This is the case of a 24-year-old patient with right hippocampal sclerosis and seizures with dizziness and visual blurring as subjective manifestations at seizure onset. He was invasively explored with a temporo-parieto-occipital-targeted SEEG implantation. An epileptogenic index corresponding to low-voltage fast activity and baseline shift is projected on the electrode locations at the seizure onset. At the moment of aura, a coupled activation is observed in the posterior hippocampus, posterior insula and precuneus. The patient underwent a right anterior temporal lobectomy in 2015 and he is currently seizure-free with Engel Class 1A (including auras) and off medication since 2016.