Abstracts

Rationale: Auras or lateralized clinical features are conventionally considered indications that a seizure is focal, rather than generalized, in nature. However, prior research questions the validity of the conventional interpretation. Making the distinction between partial and generalized seizure disorders occurs early in diagnostic evaluation andhas significant implications for therapy. We studied this hypothesis by prospectively recording reports of auras utilizing a systematic, validated questionnaire. Methods: Subjects were extracted from the Idiopathic Generalized Epilepsy (IGE) arm of the Epilepsy Phenome Genome Project (EPGP). All subjects who had typical clinical histories and EEG features of IGE but did not have focal epileptiform abnormalities on EEG were included. Responses to the standard diagnostic interview regarding grand mal seizures were then examined. This questionnaire initially required subjects to provide their own description of any subjective phenomena prior to their grand mal seizures. Subjects who provided answers to these questions were considered to have an aura. All subjects were then systematically queried regarding a variety of subjective phenomena prior to their grand mal seizures and were required to answer either "yes," "no," or "don't know," and were permitted to provide multiple affirmative answers. Results: 807 participants with IGE were identified. Among these, 537 reported grand mal seizures. Of these, 185 (34.45%) self-reported auras, with significantly higher rates of auras in female respondents than males (p=0.0001). The most commonly self-reported auras were dizziness, confusion, and conscious appreciation of increasing jerks (Table 1). Analysis of responses to the systematic query showed that 389 (72.44%) experienced at least one form of aura. The most common auras reported were changes in speech and comprehension, version of the head or other body parts, and a brief lapse of awareness (Table 2). Conclusions: Auras occur frequently in generalized epilepsy. Auras typically associated with focal epilepsy, such as gustatory, visual, auditory phenomena and déjà vu were also reported in this cohort, which may support existing theories of cortical generators of IGE with variable spread patterns. Differences between self-reported and systematically queried responses may also reflect clinically relevant variances in patient responses to history-taking and surveys.