title: Auditory aura in nocturnal frontal lobe epilepsy: a red flag to suspect an extra-frontal epileptogenic zone.
abstract: OBJECTIVE
  To describe the anatomo-electro-clinical findings of patients with nocturnal hypermotor seizures (NHS) preceded by auditory symptoms, to evaluate the localizing value of auditory aura.
  
  
  METHODS
  Our database of 165 patients with nocturnal frontal lobe epilepsy (NFLE) diagnosis confirmed by videopolysomnography (VPSG) was reviewed, selecting those who reported an auditory aura as the initial ictal symptom in at least two NHS during their lifetime.
  
  
  RESULTS
  Eleven patients were selected (seven males, four females). According to the anatomo-electro-clinical data, three groups were identified. Group 1 [defined epileptogenic zone (EZ)]: three subjects were studied with stereo-EEG. The EZ lay in the left superior temporal gyrus in two cases, whereas in the third case seizures arose from a dysplastic lesion located in the left temporal lobe. One of these three patients underwent left Heschl's gyrus resection, and is currently seizure-free. Group 2 (presumed EZ): three cases in which a presumed EZ was identified; in the left temporal lobe in two cases and in the left temporal lobe extending to the insula in one subject. Group 3 (uncertain EZ): five cases had anatomo-electro-clinical correlations discordant.
  
  
  CONCLUSIONS
  This work suggests that auditory aura may be a helpful anamnestic feature suggesting an extra-frontal seizure origin. This finding could guide secondary investigations to improve diagnostic definition and selection of candidates for surgical treatment.
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ferri
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy. Electronic address: francesca.bisulli@unibo.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bisulli
authors.affiliation: 'C. Munari' Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.
authors.forename: Lino
authors.initials: L
authors.lastname: Nobili
authors.affiliation: 'C. Munari' Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Licchetta
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mostacci
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Stipa
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Greta
authors.initials: G
authors.lastname: Mainieri
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Bernabè
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Provini
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tinuper
mesh_terms: D000328:Adult; D000368:Aged; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000473:pathology* / Q000503:physiopathology; D006212:Hallucinations / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D017286:Polysomnography
keywords: Auditory aura; Epilepsy; Epileptogenic zone; Hypermotor seizures; Localizing value; Nocturnal frontal lobe epilepsy