Abstracts

Rationale: Experiential auras (EA) have been known to be common in temporal lobe epilepsy, but their lateralizing and localizing value have not been fully elucidated. We investigated the localizing and lateralizing values of EA in patients with partial epilepsy on an outpatient basis.Methods: A total of 86 subjects who had one or more EAs were retrospectively identified from Yonsei Epilepsy Registry. EAs were classified into 5 categories: déjà vu (DV), ja­mais vu (JV), flashback (FB), disorientation (DO), and forced thinking (FT). DV, JV, and FB were categorized as memory-related EA. The scalp EEG, MRI, and if available, positron emission tomography and single photon emission computed tomography results were considered for the lobar localization (temporal (TLE), frontal, parietal, or occipital lobe) and lateralization (left or right hemisphere). TLE group was divided into mesial (MTLE), lateral, or unclassified according to the location of the lesion.Results: Fifty-four (79.4%) subjects could be classified as having a specific lobar localization and lateralization of epileptogenic foci. Five subjects had 2 concomitant EAs, so total 59 auras were analyzed. Eighteen (30.5%), 15 (25.4%), 19 (32.2%), 6 (10.2%), and 1 (1.7%) had DV, JV, FB, DO, and FT, respectively. The baseline characteristics did not differ among each EA group. Forty (74.1%) subjects had focal lesions on MRI, and 44 (81.5%) were classified as having TLE (35 with structural lesions) including 30 with involvement of mesial temporal structures (MTLE). Although not reaching statistical significance, DV showed tendency to be lateralized to the right in whole subjects (72%; p=0.151), and in TLE group (75.0%; p = 0.113). DV was lateralized to the right in subjects with MRI lesions (84.6%; p = 0.040), lesional TLE (91.7%; p = 0.013), and MTLE (90.9%; p = 0.023), respectively. There was no significant difference in lateralization of memory-related EAs and EAs other than DV. Lobar localization was not different among each EA group, except for JV showing higher probability to be in temporal lobe (89.7%; p = 0.02).Conclusions: These results suggest that DV was more lateralized to the right hemisphere, especially in epilepsy with structural lesions and TLE.