Auras are subjective and may be sensory or experiential. They reflect the initial seizure discharge. An aura may be an isolated phenomenon or progress to a focal seizure with objective features (with or without altered awareness) or to a bilateral convulsion. An aura is also known as a "warning".

Sensory aura

A sensory aura involves a sensation without an objective clinical sign. Sensory aura include the following types:

  • Somatosensory aura are characterized by sensory phenomena including tingling, numbness, electric-shock like sensation, pain, sense of movement, or desire to move. Somatosensory aura occur in seizures involving the sensorimotor cortex.
  • Visual aura are characterized by elementary visual hallucinations such as flashing or flickering lights, spots or other shapes, simple patterns, scotomata, or amaurosis. More complex visual hallucinations such as seeing formed images are considered experiential aura. Visual aura occur in seizures involving the occipital lobe, and are often colored in nature.
  • Auditory aura are characterized by elementary auditory phenomena including buzzing, ringing, drumming or single tones. More complex auditory hallucinations such as voices are considered experiential seizures. Auditory aura occur in seizures involving auditory cortex in the lateral superior temporal lobe.
  • Olfactory aura are characterized by olfactory phenomena - usually an odor, which is often unpleasant. Olfactory aura occur in seizures involving the mesial temporal or orbitofrontal regions.
  • Gustatory aura are characterized by taste phenomena including acidic, bitter, salty, sweet, or metallic tastes. Gustatory aura occur in seizures involving the parietal operculum and the insula.
  • Epigastric aura are characterized by upper abdominal phenomena including discomfort, emptiness, tightness, churning and a sensation that may rise up to the chest or throat. Epigastric aura occur in seizures involving the mesial temporal lobe.
  • Cephalic aura are characterized by a sensation in the head such as light-headedness or headache.

Experiential aura

An experiential aura involves affective, mnemonic (memory) or perceptual subjective phenomena including depersonalization and hallucinatory events; these may appear alone or in combination. Experiential aura include the following types:

  • Affective aura are characterized by phenomena such as fear, depression, joy and anger.
  • Mnemonic aura are characterized by memory phenomena such as feelings of familiarity (déjà vu) and unfamiliarity (jamais vu).
  • Hallucinatory aura are characterized by imagined complex sensory phenomena that may involve visual (e.g. formed images), auditory (e.g. hearing voices) or other sensory modalities, without change in awareness. The sensory phenomena may be accompanied by associated emotion or interpretation e.g. may be experienced as persecutory.
  • Illusory aura are characterized by an alteration of actual perception involving visual, auditory, somatosensory, olfactory, and/or gustatory phenomena, without change in awareness.
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