Abstracts

Rationale: Epileptic auras are traditionally attributed to focal epilepsies (FE). However, despite receiving less attention, subjective symptoms before or during seizures can also be reported in genetic generalized epilepsies (GGE) and may influence diagnostic and treatment choices when operating within a dichotomous seizure classification. We aimed to comprehensively characterize the subjective symptomatology among adults with GGE and compare it to the one in FE.


Methods: Between April 2023 and January 2024, we conducted a cross-sectional closed-ended survey of adult epilepsy outpatients at Vilnius University Hospital Santaros Klinikos by asking them which of the 86 subjective symptoms, classified as sensory, motor, autonomic, emotional and cognitive, they experience just before (one minute and less) or during their seizures. Participants indicated whether each symptom is always (5), frequently (4), sometimes (3), rarely (2) or never (1) present during their seizures. Each respondent had been confirmed to have either FE or GGE based on diagnostic criteria of each epilepsy type and/or syndrome before the study. The prevalence of the different groups of subjective symptoms in FE and GGE was compared using Chi-squared and Fisher’s exact tests.


Results: Of the 138 participants (average age 41.2 ±16.2 years, 87 (63%) female, average epilepsy duration 15.6 ±12.3 years), 100 (72%) had FE and 38 (28%) had GGE. Predominant epilepsy etiologies were structural (57, 41%), unknown (48, 35%) and genetic (23, 17%). Among individuals with GGE, 24 (63%) indicated feeling at least one subjective change in their bodily or mental state just before or during a seizure (in comparison, this was true for 81 (81%) participants with FE, χ²=4.818, p=0.028). Most frequently they reported non-specific symptoms (21, 55%), such as vertigo/dizziness (11, 29%), instability (9, 24%), severe fatigue (10, 26%), drowsiness (9, 24%), anxiety or fear (12, 32%), tachycardia (9, 24%) or tachypnea (7, 18%). Specific sensory symptoms (e.g., sounds, flashes etc.) were reported by 17 (45%), motor – by 14 (37%), cognitive (e.g., attention disorder, dysphasia etc.) – by 13 (34%), autonomic – by 6 (16%) and emotional – by 5 (13%) participants with GGE. While the overall prevalence of auras as well as the one of cognitive symptoms (χ²=4.912, p=0.027) was higher in FE, no statistically significant differences between epilepsy types were observed in the reported manifestation of sensory, motor, emotional, or autonomic symptoms (p >0.05).


Conclusions: While being predominantly non-specific in their quality, subjective sensations were frequently acknowledged among individuals with GGE. Except for cognitive auras, symptoms in other aura groups had similar prevalence in GGE as in FE. Our study emphasizes the need to thoroughly explore subjective peri-ictal symptomatology irrespective of suspected seizure type and suggests the use of close-ended questions as a tool for high-yield comprehensive assessment.


Funding: None.