Classification of Aura Symptoms in the Pre-ictal Phase of Seizure

Sensory Auras

Visual auras are fully reversible visual disturbances that typically spread gradually over ≥5 minutes, often unilateral and can last 5-60 minutes, and may include positive phenomena (scintillations) or negative phenomena (scotoma) 1, 2, 3, 4
Flashing lights may trigger photosensitive epilepsy, and unpleasant smell or taste sensations can occur 5
Sounds may be perceived as coming from a distance, and may range from elementary auditory hallucinations (buzzing, ringing) to complex sounds (music) 5

Rising sensation from abdomen (epigastric aura) is common in temporal lobe epilepsy, and may occasionally occur in vasovagal syncope but is more characteristic of epilepsy 5, 6
Déjà vu/jamais vu experiences can occur, and are associated with temporal lobe epilepsy 5

Palpitations may indicate tachyarrhythmia or catecholaminergic polymorphic ventricular tachycardia, and nausea and abdominal discomfort can occur 5
Gastrointestinal symptoms may be associated with autonomic activation in reflex syncope but can also occur in epilepsy 5

Auras provide important lateralizing and localizing information in presurgical assessment, and help differentiate epilepsy from other conditions like syncope 5, 6
Auras may be detectable on EEG, particularly those involving centro-parieto-occipital regions, but some auras (especially viscerosensory and experiential) may not show clear EEG correlates 2