Seizure Aura

Seizure Aura is the term used here because aura can occur with migraine headache too, where it may be called as migraine aura.

An aura is a warning manifestation (or earliest manifestation) of a seizure (or migraine headache). From here onwards the discussion will only focus about the seizures.

A seizure may have 3 distinct phases (not all seizures though); first an aura, then the main part of the seizure, and finally a post ictal state. A seizure like complex partial seizure is usually the best example where all 3 phases occur, but it can occur with other partial seizures too. Aura does not occur with primary generalized seizures.

An aura occurs prior to the main seizure activity although it may stop at that level itself, means no seizure follows aura sometimes. There is usually a pattern and this is recognized by the patient and/or the close associates of the patient who can generally tell that a distinct manifestation or set of manifestations generally occur before a seizure.

Auras may be seen or felt and there are varieties of manifestations. The auras that are felt are sensory in nature and they may be general somato sensory feelings like numbness, tingling (pins & needles), pain etc. They can be related with special senses too as below;

• Visual: seeing light, patterns, objects etc
• Auditory: hearing related – sounds, voices etc
• Olfactory: smell related – usually odd smell like burnt rubber
• Gustatory – taste related, usually strange tastes

The auras that are seen are motor activities; various focal motor activities like shaking, twitching, head or eye turning etc can occur. The same aura manifestation can continue as a seizure manifestation too.

Auras are actually themselves seizures and are considered as simple partial seizures. They represent some of the earliest clinical manifestations corresponding to the underlying electrical changes that take place in the seizure focus (epileptogenic focus). The electrical changes subsequently may spread to other areas of the brain and will present as a full blown seizure.

Yes, in a way they help us too as explained below.

The presence of aura helps in localizing the seizure focus and this is an enormously useful piece of information for neurologists and neurosurgeons, especially if surgical treatments are considered to the patient.

The seizure aura also serves as warning manifestation, especially if there is some time gap between the aura and the main seizure, so that patient or their caregivers can make arrangements for patient’s safety.