title: Auras in generalized epilepsy.
abstract: OBJECTIVE
  We studied the frequency of auras in generalized epilepsy (GE) using a detailed semistructured diagnostic interview.
  
  
  METHODS
  In this cross-sectional study, participants with GE were drawn from the Epilepsy Phenome/Genome Project (EPGP). Responses to the standardized diagnostic interview regarding tonic-clonic (grand mal) seizures were then examined. This questionnaire initially required participants to provide their own description of any subjective phenomena before their "grand mal seizures." Participants who provided answers to these questions were considered to have an aura. All participants were then systematically queried regarding a list of specific symptoms occurring before grand mal seizures, using structured (closed-ended) questions.
  
  
  RESULTS
  Seven hundred ninety-eight participants with GE were identified, of whom 530 reported grand mal seizures. Of these, 112 (21.3%) reported auras in response to the open-ended question. Analysis of responses to the closed-ended questions suggested that 341 participants (64.3%) experienced at least one form of aura.
  
  
  CONCLUSIONS
  Auras typically associated with focal epilepsy were reported by a substantial proportion of EPGP subjects with GE. This finding may support existing theories of cortical and subcortical generators of GE with variable spread patterns. Differences between responses to the open-ended question and closed-ended questions may also reflect clinically relevant variation in patient responses to history-taking and surveys. Open-ended questions may underestimate the prevalence of specific types of auras and may be in part responsible for the underrecognition of auras in GE. In addition, structured questions may influence participants, possibly leading to a greater representation of symptoms.
authors.affiliation: From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco. patricia.dugan@nyumc.org.
authors.forename: Patricia
authors.initials: P
authors.lastname: Dugan
authors.affiliation: From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco.
authors.forename: Chad
authors.initials: C
authors.lastname: Carlson
authors.affiliation: From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco.
authors.forename: Judith
authors.initials: J
authors.lastname: Bluvstein
authors.affiliation: From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Chong
authors.affiliation: From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco.
authors.forename: Daniel
authors.initials: D
authors.lastname: Friedman
authors.affiliation: From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco.
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Kirsch
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D003430:Cross-Sectional Studies; D004829:Epilepsy, Generalized / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015995:Prevalence; D012640:Seizures / Q000453:epidemiology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult