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Auras are frequent inidiopathic generalized
epilepsy
AbstractmdashThe occurrence of an aura is often considered evidence of a partialrather than an idiopathic generalized epilepsy syndrome The authors exam-ined this hypothesis by prospectively recording reports of auras by patientsbeing admitted for video-EEG monitoring Auras were equally common (70)among patients with idiopathic generalized epilepsy as they were among thosewith localization-related epilepsy Presence of an aura is not a reliable indica-tor of localization-related epilepsy
NEUROLOGY 200667343ndash345
LS Boylan MD DL Labovitz MD MS SC Jackson RN MA K Starner RN MS and O Devinsky MD
Epileptic auras are subjective symptoms that heraldfrank seizures in people with epilepsy They are clas-sically considered a sign of a partial seizure withcharacteristic phenomenology determined by the siteof onset or early spread in the brain For exampledeja vu and a rising epigastric aura are associatedwith temporal lobe epilepsy focal motor seizures re-flect ictal activity in the motor cortex and elemen-tary visual symptoms are associated with occipitallobe epilepsy The presence of an aura is consideredevidence that epilepsy is of focal origin and that anysubsequent generalized event is secondarily general-ized The distinction between a partial and general-ized onset seizure affects diagnosis treatment andprognosis The authors systematically evaluated au-ras in a series of patients admitted to an inpatientvideo-EEG monitoring unit for evaluation
Methods Data were prospectively collected from adults admit-ted to the New York University Comprehensive Epilepsy Centerinpatient video-EEG monitoring unit from April 16 2001 to Sep-tember 16 2002 This study was approved by the New York Uni-versity Institutional Review Board and all subjects gave informedconsent Inclusion criteria were age older than 17 years estab-lished epilepsy for 1 year as diagnosed by the admitting neurol-ogist ability to speak and read English and capacity to consent
Demographic and clinical information including age at epilepsyonset seizure frequency seizure subtypes medication historyand psychiatric history were recorded by the admitting residenton the day of admission using a standardized admission templateOn enrollment subjects completed a questionnaire on symptomsbefore and after seizures The questionnaire on symptoms sur-rounding seizures included the text ldquoSometimes people have awarning that they are going to have a seizure The warning maycome right before a seizure (this is often called an lsquoaurarsquo) or itmight come hours or days before a seizurerdquo Patients who an-swered in the affirmative to the question ldquoCan you tell that youare going to have a seizure seconds or minutes before it happensrdquowere considered to have an aura Subjects responding yes wereasked to provided a brief description of their symptoms (a blank ofinch of space was provided) Diagnoses of epilepsy type were basedon the final video-EEG report
p Values ( 05) were calculated with the Mantel-Haenszel2 statistic or Fisher exact test (for cell sizes 5) for categoricaldata or two-tailed t tests for continuous data
Results Complete data were available for 154 subjects(table 1) Twenty subjects had idiopathic generalized epi-lepsy (IGE) One patient with IGE also had nonepilepticseizures and reported pleomorphic auras We excluded thispatient from further analysis There were two patientswhose final video-EEG report noted features of bothlocalization-related epilepsy and IGE The first patient de-scribed her events as generalized tonic-clonic (GTC) sei-zures with an aura of ldquohiccupsrdquo Two typical events wererecorded Both consisted of initial surface negative facialand diaphragmatic myoclonus followed by a GTC seizurewith generalized EEG onset During sleep she had occa-sional temporal sharp waves She was classified as havingIGE with an aura The other patient with electrographicfeatures of both IGE and localization-related epilepsy hadtypical events consisting of GTC seizures with an aura ofldquofeeling terriblerdquo No clinical events were recorded duringmonitoring however the interictal EEG showed dailyfrontotemporal left hemisphere spike and wave activity aswell as frequent generalized bursts of spikes This patientwas categorized along with those with multifocal or extra-temporal epilepsy as having ldquoother focal epilepsyrdquo (table1) Characteristics of patients with IGE with and withoutauras are shown in table 2
Patients with IGE were just as likely to report aurasymptoms as those with localization-related epilepsy Pres-ence of an aura did not distinguish between patient groupsbased on any clinical variable except that those whoseepilepsy type remained undiagnosed at the end of video-EEG monitoring were less likely to have an aura thanthose with better characterized epilepsy syndromes (p 002) Described auras among subjects with IGE were vari-able and included a range of subjective sensations ldquoI get afeeling in my body that I just knowrdquo ldquoI get a pain in thehead or feel light-headedrdquo ldquoI get a warm sensation in mybodyrdquo ldquolike a rising feelingrdquo ldquonausea slow processingsweatingrdquo ldquostrong head rushrdquo ldquolight-headed off balancepanickyrdquo ldquopulsating feeling in left handrdquo ldquofinger or headnumbnessrdquo ldquoshaky feeling all over spacey feeling in myheadrdquo ldquofeeling coursing through my body my blood compo-sition changes Irsquom very alertrdquo One patient described avisual aura ldquocolors flow around peoplersquos bodies (not ob-jects)rdquo Two subjects reported motor phenomenon of ldquohic-cupsrdquo and ldquojumps or jerksrdquo
Auras reported repeatedly by patients with video-EEGndashconfirmed temporal lobe epilepsy (TLE) but not by those
From the New York University School of Medicine (LSB SCJ KSOD) Bellevue Hospital Center (LSB) New York University Comprehen-sive Epilepsy Center (SCJ KS OD) St Lukersquos-Roosevelt Hospital Cen-ter (DLL) New York NY
Disclosure The authors report no conflicts of interest
Received September 27 2005 Accepted in final form March 20 2006
Address correspondence and reprint requests to Dr Laura S Boylan De-partment of Neurology New York University School of Medicine 462 FirstAvenue New York NY 10016 lauraboylanmednyuedu
Copyright copy 2006 by AAN Enterprises Inc 343
with IGE included hearing complex and elementary audi-tory hallucinations (983 patients with TLE) deja vu phe-nomena (683) and olfactory or gustatory auras (683) Arange of auras that could be described as ldquorising epigastricsensationsrdquo were described by patients with TLE (1583)although some of the descriptions of aura in IGE might beconsidered to fall in this category as well (214) The pres-ence or absence of an aura was not consistently included invideo-EEG reports so we cannot comment categorically onEEG correlates of auras However when auras were spe-cifically noted as present they were generally surface neg-ative Of the 14 patients with auras and IGE seven had apremonitoring diagnosis of complex partial seizures
Discussion We found a high prevalence of aurasin IGE (70) However an array of other data high-lights other focal characteristics of IGE Animal andhuman data suggest that so-called generalized sei-zures involve selective thalamocortical networks
while sparing others1 Dense-array EEG recordingtechniques in patients with absence seizures re-vealed that onset was typically focal to the dorsolat-eral or orbital frontal cortex2 In another study mostpatients with IGE (56) had some electrographic ev-idence of focality3 Detailed video reviews of general-ized seizures revealed focal features of ictalsemiology in seven of 10 subjects in one study4 andthree of three patients with IGE found in a series of300 monitored epilepsy patients in another despitean initially generalized EEG5 The most common fo-cal feature in both reports was head version Anearlier study that systematically queried patientswith juvenile myoclonic epilepsy (JME) for the pres-ence or absence of visual aura or conscious headversion found that these were not rare6 Among sub-jects from families with both JME and idiopathicphotosensitive occipital lobe epilepsy 10 of 12 had
Table 1 Clinical characteristics of epilepsy patients with and without auras (N 154)
All subjects Subjects with an aura Subjects without an aura p Value
Age y mean (range) 385 (19ndash75) 378 (19ndash74) 396 (19ndash75) 04184
Sex no ()
Male 62 (40) 35 (56) 27 (44) 01295
Female 92 (60) 63 (68) 29 (32)
Age at epilepsy onset y mean (range) 215 (0ndash73) 196 (2ndash66) 246 (0ndash73) 00668
Duration of seizure disorder y mean (range) 170 (0ndash55) 181 (0ndash53) 151 (0ndash53) 01614
Education y mean (range) 142 (8ndash20) 141 (8ndash20) 145 (10ndash20) 04353
Current medications mean (range) 18 (0-6) 19 (0-4) 17 (0-6) 03022
Epilepsy type no ()
Idiopathic generalized 20 (13) 14 (70) 6 (30) Ref
All focal epilepsy 104 (68) 73 (70) 31 (30) 09863
Temporal 83 (54) 63 (76) 20 (24) 05862
Other focal 21 (14) 10 (48) 11 (52) 01501
Undetermined 30 (19) 11 (37) 19 (63) 00241
Laterality no ()
Left 54 (52) 38 (70) 16 (30) Ref
Right 27 (26) 21 (78) 6 (22) 04816
Bilateral 23 (22) 14 (61) 9 (39) 04165
n 94 60 patients with missing data Subjects with missing data did not differ on other measures from subjects for whom data were available
dagger For patients with focal epilepsy only
Table 2 Characteristics of patients with idiopathic generalized epilepsy with and without auras (n 19)
All subjects Subjects with an aura Subjects without an aura p Value
Age y mean (range) 301 (21ndash50) 268 (21ndash35) 370 (21ndash50) 00731
Sex no ()
Male 7 (37) 6 (86) 1 (14) 03331
Female 12 (63) 7 (58) 5 (42)
Age at epilepsy onset y mean (range) 122 (4ndash20) 130 (6ndash20) 103 (4ndash15) 02862
Duration of seizure disorder y mean (range) 179 (2ndash46) 138 (2ndash23) 267 (12ndash46) 00062
Seizure type no ()
GTC only 5 (26) 3 (60) 2 (40) Ref
GTC and absence 6 (32) 6 (100) 0 (0) 01818
GTC and myoclonic 3 (16) 2 (67) 1 (33) 05357
GTC absence and myoclonic 5 (26) 2 (40) 3 (60) 03968
All subjects had generalized tonic-clonic seizures
GTC generalized tonic clonic
344 NEUROLOGY 67 July (2 of 2) 2006
visual auras and six of 12 had conscious head ver-sion Even among patients with sporadic JME threeof 40 reported visual auras and two of 40 had con-scious head version
In our sample auras were found just as oftenamong those with IGE as among those withlocalization-related epilepsy Auditory olfactory andgustatory as well as deja vu auras were reportedcommonly by patients with TLE but not at all bythose with IGE In contrast symptoms that could becategorized under the rubric of a ldquorising epigastricsensationrdquo were seen in both IGE and TLE
Patients not reporting an aura were less likely tobe given an epilepsy characterization at the end ofmonitoring perhaps reflecting greater hesitancy ofdiagnosticians in these circumstances (table 1)Among patients with IGE those with an aura had asignificantly shorter duration of seizure disorderthan those without an aura (table 2) possibly reflect-ing earlier referral for monitoring among patientswith aura as patients with partial epilepsy may becandidates for surgical intervention Indeed half ofthe patients with auras and IGE were thought at thetime of admission to be having complex partial sei-zures The rates of aura are higher among men thanamong women and among those with both GTC andabsence seizures (table 2) but these differences did
not reach significance and further investigation isneeded
Even accounting for referral bias it is reasonableto conclude that the presence of auras is not rare inIGE and should not be relied on for diagnosis of typeof epilepsy The presence of auras in IGE suggests arole for focal hyperexcitability in the genesis of sei-zures characterized by generalized onset as mea-sured by conventional surface EEG Elucidation ofunderlying mechanisms of this focal activity maycontribute to the development of seizure predictionalgorithms and novel therapeutic approaches in IGE
References1 Blumenfeld H From molecules to networks corticalsubcortical interac-
tions in the pathophysiology of idiopathic generalized epilepsy Epilepsia200344(suppl 2)7ndash15
2 Holmes MD Brown M Tucker DM Are ldquogeneralizedrdquo seizures trulygeneralized Evidence of localized mesial frontal and frontopolar dis-charges in absence Epilepsia 2004451568ndash1579
3 Lombroso CT Consistent EEG focalities detected in subjects with pri-mary generalized epilepsies monitored for two decades Epilepsia 199738797ndash812
4 Niaz FE Abou-Khalil B Fakhoury T The generalized tonic-clonic sei-zure in partial versus generalized epilepsy semiologic differences Epi-lepsia 1999401664ndash1666
5 Casaubon L Pohlmann-Eden B Khosravani H Carlen PL Wennberg RVideo-EEG evidence of lateralized clinical features in primary general-ized epilepsy with tonic-clonic seizures Epileptic Disord 20035149ndash156
6 Taylor I Marini C Johnson MR Turner S Berkovic SF Scheffer IEJuvenile myoclonic epilepsy and idiopathic photosensitive occipital lobeepilepsy is there overlap Brain 20041271878ndash1886
ACCESS wwwneurologyorg NOWFOR FULL-TEXT ARTICLES
Neurology online is now available to all subscribers Our online version features extensive search capability by title keywords article key words and author names Subscribers can search full-text article Neurology archives to 1999 andcan access link references with PubMed The one-time activation requires only your subscriber number whichappears on your mailing label If this label is not available to you call 1-800-638-3030 (United States) or 1-301-714-2300 (outside United States) to obtain this number
July (2 of 2) 2006 NEUROLOGY 67 345
DOI 10121201wnl00002251853708197200667343-345 Neurology
L S Boylan D L Labovitz S C Jackson et al Auras are frequent in idiopathic generalized epilepsy
This information is current as of July 24 2006
ServicesUpdated Information amp
httpwwwneurologyorgcontent672343fullhtmlincluding high resolution figures can be found at
References httpwwwneurologyorgcontent672343fullhtmlref-list-1
This article cites 5 articles 1 of which you can access for free at
Citations httpwwwneurologyorgcontent672343fullhtmlotherarticles
This article has been cited by 1 HighWire-hosted articles
Subspecialty Collections
httpwwwneurologyorgcgicollectionclinical_neurology_historyClinical neurology history
httpwwwneurologyorgcgicollectionantiepileptic_drugsAntiepileptic drugs
httpwwwneurologyorgcgicollectionall_epilepsy_seizuresAll EpilepsySeizuresfollowing collection(s) This article along with others on similar topics appears in the
Permissions amp Licensing
httpwwwneurologyorgmiscaboutxhtmlpermissionsits entirety can be found online atInformation about reproducing this article in parts (figurestables) or in
Reprints
httpwwwneurologyorgmiscaddirxhtmlreprintsusInformation about ordering reprints can be found online
Online ISSN 1526-632X1951 it is now a weekly with 48 issues per year Copyright All rights reserved Print ISSN 0028-3878
reg is the official journal of the American Academy of Neurology Published continuously sinceNeurology
with IGE included hearing complex and elementary audi-tory hallucinations (983 patients with TLE) deja vu phe-nomena (683) and olfactory or gustatory auras (683) Arange of auras that could be described as ldquorising epigastricsensationsrdquo were described by patients with TLE (1583)although some of the descriptions of aura in IGE might beconsidered to fall in this category as well (214) The pres-ence or absence of an aura was not consistently included invideo-EEG reports so we cannot comment categorically onEEG correlates of auras However when auras were spe-cifically noted as present they were generally surface neg-ative Of the 14 patients with auras and IGE seven had apremonitoring diagnosis of complex partial seizures
Discussion We found a high prevalence of aurasin IGE (70) However an array of other data high-lights other focal characteristics of IGE Animal andhuman data suggest that so-called generalized sei-zures involve selective thalamocortical networks
while sparing others1 Dense-array EEG recordingtechniques in patients with absence seizures re-vealed that onset was typically focal to the dorsolat-eral or orbital frontal cortex2 In another study mostpatients with IGE (56) had some electrographic ev-idence of focality3 Detailed video reviews of general-ized seizures revealed focal features of ictalsemiology in seven of 10 subjects in one study4 andthree of three patients with IGE found in a series of300 monitored epilepsy patients in another despitean initially generalized EEG5 The most common fo-cal feature in both reports was head version Anearlier study that systematically queried patientswith juvenile myoclonic epilepsy (JME) for the pres-ence or absence of visual aura or conscious headversion found that these were not rare6 Among sub-jects from families with both JME and idiopathicphotosensitive occipital lobe epilepsy 10 of 12 had
Table 1 Clinical characteristics of epilepsy patients with and without auras (N 154)
All subjects Subjects with an aura Subjects without an aura p Value
Age y mean (range) 385 (19ndash75) 378 (19ndash74) 396 (19ndash75) 04184
Sex no ()
Male 62 (40) 35 (56) 27 (44) 01295
Female 92 (60) 63 (68) 29 (32)
Age at epilepsy onset y mean (range) 215 (0ndash73) 196 (2ndash66) 246 (0ndash73) 00668
Duration of seizure disorder y mean (range) 170 (0ndash55) 181 (0ndash53) 151 (0ndash53) 01614
Education y mean (range) 142 (8ndash20) 141 (8ndash20) 145 (10ndash20) 04353
Current medications mean (range) 18 (0-6) 19 (0-4) 17 (0-6) 03022
Epilepsy type no ()
Idiopathic generalized 20 (13) 14 (70) 6 (30) Ref
All focal epilepsy 104 (68) 73 (70) 31 (30) 09863
Temporal 83 (54) 63 (76) 20 (24) 05862
Other focal 21 (14) 10 (48) 11 (52) 01501
Undetermined 30 (19) 11 (37) 19 (63) 00241
Laterality no ()
Left 54 (52) 38 (70) 16 (30) Ref
Right 27 (26) 21 (78) 6 (22) 04816
Bilateral 23 (22) 14 (61) 9 (39) 04165
n 94 60 patients with missing data Subjects with missing data did not differ on other measures from subjects for whom data were available
dagger For patients with focal epilepsy only
Table 2 Characteristics of patients with idiopathic generalized epilepsy with and without auras (n 19)
All subjects Subjects with an aura Subjects without an aura p Value
Age y mean (range) 301 (21ndash50) 268 (21ndash35) 370 (21ndash50) 00731
Sex no ()
Male 7 (37) 6 (86) 1 (14) 03331
Female 12 (63) 7 (58) 5 (42)
Age at epilepsy onset y mean (range) 122 (4ndash20) 130 (6ndash20) 103 (4ndash15) 02862
Duration of seizure disorder y mean (range) 179 (2ndash46) 138 (2ndash23) 267 (12ndash46) 00062
Seizure type no ()
GTC only 5 (26) 3 (60) 2 (40) Ref
GTC and absence 6 (32) 6 (100) 0 (0) 01818
GTC and myoclonic 3 (16) 2 (67) 1 (33) 05357
GTC absence and myoclonic 5 (26) 2 (40) 3 (60) 03968
All subjects had generalized tonic-clonic seizures
GTC generalized tonic clonic
344 NEUROLOGY 67 July (2 of 2) 2006
visual auras and six of 12 had conscious head ver-sion Even among patients with sporadic JME threeof 40 reported visual auras and two of 40 had con-scious head version
In our sample auras were found just as oftenamong those with IGE as among those withlocalization-related epilepsy Auditory olfactory andgustatory as well as deja vu auras were reportedcommonly by patients with TLE but not at all bythose with IGE In contrast symptoms that could becategorized under the rubric of a ldquorising epigastricsensationrdquo were seen in both IGE and TLE
Patients not reporting an aura were less likely tobe given an epilepsy characterization at the end ofmonitoring perhaps reflecting greater hesitancy ofdiagnosticians in these circumstances (table 1)Among patients with IGE those with an aura had asignificantly shorter duration of seizure disorderthan those without an aura (table 2) possibly reflect-ing earlier referral for monitoring among patientswith aura as patients with partial epilepsy may becandidates for surgical intervention Indeed half ofthe patients with auras and IGE were thought at thetime of admission to be having complex partial sei-zures The rates of aura are higher among men thanamong women and among those with both GTC andabsence seizures (table 2) but these differences did
not reach significance and further investigation isneeded
Even accounting for referral bias it is reasonableto conclude that the presence of auras is not rare inIGE and should not be relied on for diagnosis of typeof epilepsy The presence of auras in IGE suggests arole for focal hyperexcitability in the genesis of sei-zures characterized by generalized onset as mea-sured by conventional surface EEG Elucidation ofunderlying mechanisms of this focal activity maycontribute to the development of seizure predictionalgorithms and novel therapeutic approaches in IGE
References1 Blumenfeld H From molecules to networks corticalsubcortical interac-
tions in the pathophysiology of idiopathic generalized epilepsy Epilepsia200344(suppl 2)7ndash15
2 Holmes MD Brown M Tucker DM Are ldquogeneralizedrdquo seizures trulygeneralized Evidence of localized mesial frontal and frontopolar dis-charges in absence Epilepsia 2004451568ndash1579
3 Lombroso CT Consistent EEG focalities detected in subjects with pri-mary generalized epilepsies monitored for two decades Epilepsia 199738797ndash812
4 Niaz FE Abou-Khalil B Fakhoury T The generalized tonic-clonic sei-zure in partial versus generalized epilepsy semiologic differences Epi-lepsia 1999401664ndash1666
5 Casaubon L Pohlmann-Eden B Khosravani H Carlen PL Wennberg RVideo-EEG evidence of lateralized clinical features in primary general-ized epilepsy with tonic-clonic seizures Epileptic Disord 20035149ndash156
6 Taylor I Marini C Johnson MR Turner S Berkovic SF Scheffer IEJuvenile myoclonic epilepsy and idiopathic photosensitive occipital lobeepilepsy is there overlap Brain 20041271878ndash1886
ACCESS wwwneurologyorg NOWFOR FULL-TEXT ARTICLES
Neurology online is now available to all subscribers Our online version features extensive search capability by title keywords article key words and author names Subscribers can search full-text article Neurology archives to 1999 andcan access link references with PubMed The one-time activation requires only your subscriber number whichappears on your mailing label If this label is not available to you call 1-800-638-3030 (United States) or 1-301-714-2300 (outside United States) to obtain this number
July (2 of 2) 2006 NEUROLOGY 67 345
DOI 10121201wnl00002251853708197200667343-345 Neurology
L S Boylan D L Labovitz S C Jackson et al Auras are frequent in idiopathic generalized epilepsy
This information is current as of July 24 2006
ServicesUpdated Information amp
httpwwwneurologyorgcontent672343fullhtmlincluding high resolution figures can be found at
References httpwwwneurologyorgcontent672343fullhtmlref-list-1
This article cites 5 articles 1 of which you can access for free at
Citations httpwwwneurologyorgcontent672343fullhtmlotherarticles
This article has been cited by 1 HighWire-hosted articles
Subspecialty Collections
httpwwwneurologyorgcgicollectionclinical_neurology_historyClinical neurology history
httpwwwneurologyorgcgicollectionantiepileptic_drugsAntiepileptic drugs
httpwwwneurologyorgcgicollectionall_epilepsy_seizuresAll EpilepsySeizuresfollowing collection(s) This article along with others on similar topics appears in the
Permissions amp Licensing
httpwwwneurologyorgmiscaboutxhtmlpermissionsits entirety can be found online atInformation about reproducing this article in parts (figurestables) or in
Reprints
httpwwwneurologyorgmiscaddirxhtmlreprintsusInformation about ordering reprints can be found online
Online ISSN 1526-632X1951 it is now a weekly with 48 issues per year Copyright All rights reserved Print ISSN 0028-3878
reg is the official journal of the American Academy of Neurology Published continuously sinceNeurology
visual auras and six of 12 had conscious head ver-sion Even among patients with sporadic JME threeof 40 reported visual auras and two of 40 had con-scious head version
In our sample auras were found just as oftenamong those with IGE as among those withlocalization-related epilepsy Auditory olfactory andgustatory as well as deja vu auras were reportedcommonly by patients with TLE but not at all bythose with IGE In contrast symptoms that could becategorized under the rubric of a ldquorising epigastricsensationrdquo were seen in both IGE and TLE
Patients not reporting an aura were less likely tobe given an epilepsy characterization at the end ofmonitoring perhaps reflecting greater hesitancy ofdiagnosticians in these circumstances (table 1)Among patients with IGE those with an aura had asignificantly shorter duration of seizure disorderthan those without an aura (table 2) possibly reflect-ing earlier referral for monitoring among patientswith aura as patients with partial epilepsy may becandidates for surgical intervention Indeed half ofthe patients with auras and IGE were thought at thetime of admission to be having complex partial sei-zures The rates of aura are higher among men thanamong women and among those with both GTC andabsence seizures (table 2) but these differences did
not reach significance and further investigation isneeded
Even accounting for referral bias it is reasonableto conclude that the presence of auras is not rare inIGE and should not be relied on for diagnosis of typeof epilepsy The presence of auras in IGE suggests arole for focal hyperexcitability in the genesis of sei-zures characterized by generalized onset as mea-sured by conventional surface EEG Elucidation ofunderlying mechanisms of this focal activity maycontribute to the development of seizure predictionalgorithms and novel therapeutic approaches in IGE
References1 Blumenfeld H From molecules to networks corticalsubcortical interac-
tions in the pathophysiology of idiopathic generalized epilepsy Epilepsia200344(suppl 2)7ndash15
2 Holmes MD Brown M Tucker DM Are ldquogeneralizedrdquo seizures trulygeneralized Evidence of localized mesial frontal and frontopolar dis-charges in absence Epilepsia 2004451568ndash1579
3 Lombroso CT Consistent EEG focalities detected in subjects with pri-mary generalized epilepsies monitored for two decades Epilepsia 199738797ndash812
4 Niaz FE Abou-Khalil B Fakhoury T The generalized tonic-clonic sei-zure in partial versus generalized epilepsy semiologic differences Epi-lepsia 1999401664ndash1666
5 Casaubon L Pohlmann-Eden B Khosravani H Carlen PL Wennberg RVideo-EEG evidence of lateralized clinical features in primary general-ized epilepsy with tonic-clonic seizures Epileptic Disord 20035149ndash156
6 Taylor I Marini C Johnson MR Turner S Berkovic SF Scheffer IEJuvenile myoclonic epilepsy and idiopathic photosensitive occipital lobeepilepsy is there overlap Brain 20041271878ndash1886
ACCESS wwwneurologyorg NOWFOR FULL-TEXT ARTICLES
Neurology online is now available to all subscribers Our online version features extensive search capability by title keywords article key words and author names Subscribers can search full-text article Neurology archives to 1999 andcan access link references with PubMed The one-time activation requires only your subscriber number whichappears on your mailing label If this label is not available to you call 1-800-638-3030 (United States) or 1-301-714-2300 (outside United States) to obtain this number
July (2 of 2) 2006 NEUROLOGY 67 345
DOI 10121201wnl00002251853708197200667343-345 Neurology
L S Boylan D L Labovitz S C Jackson et al Auras are frequent in idiopathic generalized epilepsy
This information is current as of July 24 2006
ServicesUpdated Information amp
httpwwwneurologyorgcontent672343fullhtmlincluding high resolution figures can be found at
References httpwwwneurologyorgcontent672343fullhtmlref-list-1
This article cites 5 articles 1 of which you can access for free at
Citations httpwwwneurologyorgcontent672343fullhtmlotherarticles
This article has been cited by 1 HighWire-hosted articles
Subspecialty Collections
httpwwwneurologyorgcgicollectionclinical_neurology_historyClinical neurology history
httpwwwneurologyorgcgicollectionantiepileptic_drugsAntiepileptic drugs
httpwwwneurologyorgcgicollectionall_epilepsy_seizuresAll EpilepsySeizuresfollowing collection(s) This article along with others on similar topics appears in the
Permissions amp Licensing
httpwwwneurologyorgmiscaboutxhtmlpermissionsits entirety can be found online atInformation about reproducing this article in parts (figurestables) or in
Reprints
httpwwwneurologyorgmiscaddirxhtmlreprintsusInformation about ordering reprints can be found online
Online ISSN 1526-632X1951 it is now a weekly with 48 issues per year Copyright All rights reserved Print ISSN 0028-3878
reg is the official journal of the American Academy of Neurology Published continuously sinceNeurology
DOI 10121201wnl00002251853708197200667343-345 Neurology
L S Boylan D L Labovitz S C Jackson et al Auras are frequent in idiopathic generalized epilepsy
This information is current as of July 24 2006
ServicesUpdated Information amp
httpwwwneurologyorgcontent672343fullhtmlincluding high resolution figures can be found at
References httpwwwneurologyorgcontent672343fullhtmlref-list-1
This article cites 5 articles 1 of which you can access for free at
Citations httpwwwneurologyorgcontent672343fullhtmlotherarticles
This article has been cited by 1 HighWire-hosted articles
Subspecialty Collections
httpwwwneurologyorgcgicollectionclinical_neurology_historyClinical neurology history
httpwwwneurologyorgcgicollectionantiepileptic_drugsAntiepileptic drugs
httpwwwneurologyorgcgicollectionall_epilepsy_seizuresAll EpilepsySeizuresfollowing collection(s) This article along with others on similar topics appears in the
Permissions amp Licensing
httpwwwneurologyorgmiscaboutxhtmlpermissionsits entirety can be found online atInformation about reproducing this article in parts (figurestables) or in
Reprints
httpwwwneurologyorgmiscaddirxhtmlreprintsusInformation about ordering reprints can be found online
Online ISSN 1526-632X1951 it is now a weekly with 48 issues per year Copyright All rights reserved Print ISSN 0028-3878
reg is the official journal of the American Academy of Neurology Published continuously sinceNeurology
