Abstracts

Rationale: We analyzed the distribution of different aura types in temporal lobe epilepsy (TLE) in relation to seizure origin (mesial versus extra-mesial; left versus right). Methods: Video-EEG-documented seizures of 97 adult TLE patients were studied. Patients were were requested to describe their type of aura. Results: a) In general, aura was significantly more frequent in mesial TLE, as compared to extra-mesial TLE; there was no statistically significant difference concerning lateralization. b) In the mesial group, we observed a homogeneous pattern of aura types, mainly represented by epigastric aura (55.6%), fear (20.4%), unspecific aura (14.9%), or somatosensory aura (11.1%). In contrast, the extra-mesial group showed a very heterogeneous distribution of aura types. c) Noticeable distributions were observed for the following aura types: Epigastric aura occurred significantly more frequently in mesial TLE, when compared to extra-mesial TLE; however, without significant difference concerning lateralization. Olfactory aura and nausea occurred very rarely, but exclusively in mesial TLE. d) In some patients, two or three different aura types occurred during one seizure. In the mesial group, we found a homogeneous pattern: here, patients always reported either epigastric aura or fear, combined with other aura types. In the extra-mesial group, such a regular pattern was not observed. e) Finally, we analyzed the most frequent aura types epigastric aura, fear, unspecific aura, and somatosensory aura for the first semiological element occurring directly after the aura. Epigastric aura was mainly followed by restlessness, oral automatisms, or behavioural arrest, while the other aura types did not show a prefered distribution of first objective seizure elements. Conclusions: In conclusion, the occurrence of aura, the type of aura, and the first objective seizure element occuring directly after aura may give useful information concerning differentiation of seizure onset in TLE.