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  • Updated 03.07.2024
  • Released 03.07.2024
  • Expires For CME 03.07.2027

Focal sensory seizures with elementary symptoms



Aura is part of a seizure that occurs before consciousness is impaired and for which memory is later retained. It reflects involvement of the non-silent cortex at seizure onset and remains a useful indicator for epileptogenic zone localization (01). Auras arising from the primary sensory cortex closely mirror its functions and are referred to as elementary symptoms; they carry the best localization value during presurgical evaluation. Hence, identifying this phenomenon in seizure semiology is of prime importance. Auras include somatosensory, visual, auditory, olfactory, and gustatory symptoms.

Key points

• Auras are often underrecognized in clinical practice but have prime importance in seizure localization.

• Elementary auras arise from primary sensory cortices, and as the seizure involves associated areas, they become more complex.

• Medical management of elementary auras is the same as for focal seizures.

• Prompt consideration of alternate clinical possibilities is required to avoid inappropriate treatment.

• Identification of the red flags in the localization of aura, along with proper correlation to the EEG and radiological data, is mandatory to improve seizure outcomes after surgery in drug-resistant focal epilepsies.

Historical note and terminology

The term aura refers to “breeze” and originates in Roman and Greek mythology. “Aura” was a Goddess who was raped by Dionysus and became the mother of twins. She kept rage in mind throughout pregnancy, tried to kill her children, and murdered one of them. After a sequence of suicide attempts, she jumped into the river Sangarius and was transformed into a spring.

The first description of aura in literature came as early as the 2nd century AD in the work of a physician, Aretaeus of Alexandria, who described a wide variety of auras associated with epilepsy, including olfactory, vertiginous, visceral, visual, auditory, and gustatory auras (25). Later descriptions of the phenomenon came from Galen, one of Aretaeus’ contemporaries, around 200 AD.

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