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  • Updated 01.18.2024
  • Released 05.04.2001
  • Expires For CME 01.18.2027

Aura continua



Focal seizures may begin with a somatosensory, special sensory, visceral, or experiential aura, depending on the localization of the epileptic discharge. Typically, an aura lasts seconds to minutes, is stereotyped, and evolves to other ictal clinical features, including loss of awareness. If an aura occurs in isolation without further progression, it is more appropriately called a focal aware seizure, according to the 2017 ILAE Classification of the Epilepsies. Rarely, such symptoms last hours to days (and rarely even years) and are then called “aura continua,” ie, representing a form of focal status epilepticus. As with epilepsia partialis continua, the motor counterpart to aura continua, the understanding of the nature of the aura continua in terms of exact pathophysiology awaits clarification.

Key points

• Aura continua is a rare phenomenon, difficult to diagnosis, and often occurring with other forms of seizures in the same individual.

• Therapeutic medication trials or specialized testing may be needed to firmly establish the diagnosis.

• Aura continua has varied clinical manifestations, depending on the cortical region of origin, and is often associated with an underlying focal cortical lesion.

• Treatment of aura continua is often difficult and complete seizure freedom is not always possible.

Historical note and terminology

The term "aura" usually refers to that portion of a seizure experienced before impaired awareness occurs and for which memory is retained. In the case of a focal aware seizure, the aura is the entire seizure; however, where awareness is subsequently impaired, the aura is, in fact, the first symptom of a focal seizures with impaired awareness (19).

Scott and Masland first describe somatosensory hallucinations as a "continuous symptom" of an "aura continua” (66). The term "aura continua" can be found in Karbowski as a synonym for continuous psychomotor status (37; 93). Wolf used it as synonym for "status epilepticus of focal sensory seizures" or for hallucinosis (98).

The revised 2015 ILAE status epilepticus classification utilizes four axes: (1) seizure semiology, (2) etiology, (3) EEG correlates, and (4) age to classify status epilepticus (78). In this classification system, aura continua is listed in axis 1 under “Section B.2.b.a,” which includes seizures without prominent motor symptoms and without impairment of consciousness. Under this classification system, there is no specific minimum time duration for seizures to be considered status epilepticus. Instead, seizures are considered to be status epilepticus when there is “failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms which lead to abnormally prolonged seizures (after time point t1). It is a condition that can have long-term consequences (after time point t2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.” For focal status epilepticus with impaired consciousness, t1 (time when a seizure is likely to be prolonged leading to continuous seizure activity) is thought to occur at around 10 minutes. However, a t1 time duration has not been proposed specifically for focal seizures without impaired consciousness, including aura continua.

In the unified EEG terminology and criteria for nonconvulsive status epilepticus published in 2013, aura continua is classified as a form of nonconvulsive status epilepticus without coma or stupor with focal onset and without impairment of consciousness (04).

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