What are the signs and symptoms of aura in first adult seizure?

Updated: Nov 30, 2017
  • Author: Eissa Ibrahim AlEissa, MD, MBBS; Chief Editor: Selim R Benbadis, MD  more...
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History remains the key in obtaining a correct diagnosis in patients with first seizure in adulthood. The detailed description of the actual episode in question is particularly important. The description should be obtained separately from the patient and from a caregiver who has witnessed the event.

The patient may be able to report a warning or aura and the feeling after the seizure. The presence of an aura, by definition, makes the diagnosis of a localization-related epilepsy, because auras are “simple partial” seizures with subjective symptoms. However, not every warning symptom is an aura.

Generally speaking, in order to be considered auras, the symptoms should be brief (seconds) and followed, at least some of the time, by more definite seizure. Auras widely vary but tend to be stereotyped in a given patient. Some (eg, déjà-vu, fear, epigastric sensation, lateralized somatosensory or visual phenomena) are very specific and even localizing; others are not (eg, indescribable sensation, whole body sensations, other vague symptoms like dizziness). The patient may not be able to describe the symptoms during the seizure, which speaks to loss of awareness, but says that the “next thing I know is coming to.”

The caregivers or witnesses should then describe what they observe; having the caregivers mimic the types of movements or behaviors they see during the attacks may be helpful. Occasionally, the best witnesses are not present; this may require a telephone call.

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