title: Multiple auras: clinical significance and pathophysiology.
abstract: BACKGROUND
  Patients with partial epilepsy may report multiple types of aura during their seizures. The significance of the occurrence of multiple auras in the same patient is not known.
  
  
  METHODS
  The clinical and electrophysiologic characteristics of patients with more than one aura type (abdominal, auditory, autonomic, gustatory, olfactory, psychic, somatosensory, and visual auras), evaluated in the Cleveland Clinic epilepsy monitoring unit between 1989 and 2005, were studied.
  
  
  RESULTS
  Thirty-one patients experienced multiple aura types during a seizure. Ninety percent of patients with at least two aura types (n = 31) and 100% percent of patients with at least three aura types (n = 12) had seizures arising from the right/nondominant hemisphere. EEG seizures remained restricted in all patients during their auras. nineteen [corrected] patients had epilepsy surgery with seizure freedom in 53%. Subdural EEG recordings in six patients showed either a march of sequential auras, or in one case, several ictal onset zones resulting in separate isolated auras. Ictal SPECT in six patients with right-sided seizures showed a lack of activation in brainstem structures.
  
  
  CONCLUSIONS
  Most patients who report multiple aura types have localized epilepsy in the nondominant hemisphere, and are good surgical candidates. A common mechanism for multiple auras may be a spreading but restricted EEG seizure activating sequential symptomatogenic zones, but without the ictal activation of deeper structures or contralateral spread to cause loss of awareness and amnesia for the auras.
authors: Cleveland Clinic Epilepsy Center, Cleveland Clinic, Cleveland, OH 44195, USA.
authors: P
authors: P
authors: Widdess-Walsh
authors: P
authors: P
authors: Kotagal
authors: L
authors: L
authors: Jeha
authors: G
authors: G
authors: Wu
authors: R
authors: R
authors: Burgess
mesh_terms: D001921:Brain / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D018450:Disease Progression; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000503:physiopathology*; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D015899:Tomography, Emission-Computed, Single-Photon