Characteristics of auras in patients undergoing temporal lobectomy: Clinical article

Devin K. Binder, Paul A. Garcia, Ganesh K. Elangovan, Nicholas Barbaro

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Object. Prior studies suggest that aura semiology may have localizing value. However, temporal lobe aura characteristics and response to surgery have not been studied in large patient series. Methods. The authors retrospectively analyzed the case records of 182 patients undergoing temporal lobectomy for medically intractable epilepsy at a single institution. They analyzed the frequency and type of auras and seizures preoperatively, and at 3 months and 1 year after temporal lobectomy. Auras were divided into medial semiology (rising epigastric, olfactory/gustatory, experiential, and fear) and lateral semiology (auditory, somatosensory, and visual), or other. Results. Of 182 patients, 150 were included in this study. The preoperative prevalence of auras was 77%. Multiple types of auras were present in 20% of patients. The most common aura was rising epigastric (26% of all auras). Postoperatively, auras were eliminated in 63% of patients at 3 months and in 64% at 1 year. Seventy-seven patients (51%) were seizure-free and aura-free, 22 (15%) were seizure-free with auras, 26 (17%) had seizures but no auras, and 25 (17%) had seizures with auras. Despite having their auras eliminated, 6.7% of patients continued to have complex partial seizures. Lateral temporal auras were more than twice as likely as medial temporal auras to persist after surgery (p <0.002). Conclusions. While the majority of patients in the authors' series became seizure- and aura-free, a significant minority still had persistent auras. Patients with lateral temporal auras appear to be at increased risk for having persistent postoperative auras. The discrepancy between aura and seizure outcomes results in a small group of patients having persistent seizures but losing their auras postoperatively.

Original languageEnglish (US)
Pages (from-to)1283-1289
Number of pages7
JournalJournal of Neurosurgery
Volume111
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Epilepsy
Seizures
Temporal Lobe

Keywords

  • Amygdala
  • Aura
  • Epilepsy
  • Hippocampus
  • Seizures
  • Semiology

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Characteristics of auras in patients undergoing temporal lobectomy : Clinical article. / Binder, Devin K.; Garcia, Paul A.; Elangovan, Ganesh K.; Barbaro, Nicholas.

In: Journal of Neurosurgery, Vol. 111, No. 6, 12.2009, p. 1283-1289.

Research output: Contribution to journalArticle

Binder, Devin K. ; Garcia, Paul A. ; Elangovan, Ganesh K. ; Barbaro, Nicholas. / Characteristics of auras in patients undergoing temporal lobectomy : Clinical article. In: Journal of Neurosurgery. 2009 ; Vol. 111, No. 6. pp. 1283-1289.
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abstract = "Object. Prior studies suggest that aura semiology may have localizing value. However, temporal lobe aura characteristics and response to surgery have not been studied in large patient series. Methods. The authors retrospectively analyzed the case records of 182 patients undergoing temporal lobectomy for medically intractable epilepsy at a single institution. They analyzed the frequency and type of auras and seizures preoperatively, and at 3 months and 1 year after temporal lobectomy. Auras were divided into medial semiology (rising epigastric, olfactory/gustatory, experiential, and fear) and lateral semiology (auditory, somatosensory, and visual), or other. Results. Of 182 patients, 150 were included in this study. The preoperative prevalence of auras was 77{\%}. Multiple types of auras were present in 20{\%} of patients. The most common aura was rising epigastric (26{\%} of all auras). Postoperatively, auras were eliminated in 63{\%} of patients at 3 months and in 64{\%} at 1 year. Seventy-seven patients (51{\%}) were seizure-free and aura-free, 22 (15{\%}) were seizure-free with auras, 26 (17{\%}) had seizures but no auras, and 25 (17{\%}) had seizures with auras. Despite having their auras eliminated, 6.7{\%} of patients continued to have complex partial seizures. Lateral temporal auras were more than twice as likely as medial temporal auras to persist after surgery (p <0.002). Conclusions. While the majority of patients in the authors' series became seizure- and aura-free, a significant minority still had persistent auras. Patients with lateral temporal auras appear to be at increased risk for having persistent postoperative auras. The discrepancy between aura and seizure outcomes results in a small group of patients having persistent seizures but losing their auras postoperatively.",
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