Abstracts

RATIONALE: Initial seizures are important indications for lateralization in focal epilepsies. There is a group among the various aura symptoms which is called visceral or autonomic auras. In addition to epigastric or abdominal signs, cardiovascular, respiratory, pupillary, genital, vasomotor, urinary, hyperscretive and pilomotor signs were reported. The previous investigations published in the literature leave one question unanswered: Do singular visceral types of auras give information regarding the localisation or lateralisation of the epileptic activity by which they are caused? Patients with pharmaco-resistant partial epilepsies with cold shiver and or pilomotor excitation during focal seizures were examined.
METHODS: 17 patients were examined by means of video-EEG long time recording (30-64 channel-scalp-sphenoidal or invasive subdural electrodes), MRI and SPECT. The results of preoperative investigations were correlated to the type of autonomic aura (cold shiver or cold sweat, goose flesh). The binomial test was used to compare the observed frequencies of focus sides in patients with cold shiver and with expected frequencies (p=0.5 for both focus groups)
RESULTS: In patients with cold shiver and/or goose flesh the ictal onset was lateralized to the left hemisphere in 14 out of 17 patints (82%). This proved to be statistically significant (p=0.013). Goose flesh was observed in the following parts of the body: Face and upper body (n=2), both arms(n=3), gluteal region (n=1).
CONCLUSIONS: Our findings indicate that a systematic analysis of autonomic auras leads to an even more differentiated interpretation of subgroups of autonomic auras. The precise differentiation of these subgroups may provide important clinical hints for the lateralization or even localization in presurgical evaluation.
Support: No funding