Pediatric extratemporal epilepsy presenting with a complex auditory aura

Dave F. Clarke, Frederick Boop, Amy L. McGregor, F. Frederick Perkins, Vickie R. Brewer, James Wheless

Research output: Contribution to journalComment/debate

3 Citations (Scopus)

Abstract

Introduction. Ear plugging (placing fingers in or covering the ears) is a clinical seizure semiology that has been described as a response to an unformed, auditory hallucination localized to the superior temporal neocortex. The localizing value of ear plugging in more complex auditory hallucinations may have more involved circuitry. We report on one child, whose aura was a more complex auditory phenomenon, consisting of a door opening and closing, getting louder as the ictus persisted. Methods. This child presented, at four years of age, with brief episodes of ear plugging followed by an acute emotional change that persisted until surgical resection of a left mesial frontal lesion at 11 years of age. Scalp video-EEG, magnetic resource imaging, magnetoen- cephalography, and invasive video-EEG monitoring were carried out. Results. The scalp EEG changes always started after clinical onset. These were not localizing, and encompassed a wide field over the bi-frontal head regions, the left side predominant over the right. Intracranial video-EEG monitoring with subdural electrodes over both frontal and temporal regions localized the seizure-onset to the left mesial frontal lesion. The patient has remained seizure-free since the resection on June 28, 2006, approximately one and a half years ago. Conclusion. Ear plugging in response to simple auditory auras localize to the superior temporal gyrus. If the patient has more complex, formed auditory auras, not only may the secondary auditory areas in the temporal lobe be involved, but one has to entertain the possibility of ictal-onset from the frontal cortex. [Published with video sequences].

Original languageEnglish (US)
Pages (from-to)181-186
Number of pages6
JournalEpileptic Disorders
Volume10
Issue number2
DOIs
StatePublished - Jun 2008

Fingerprint

Ear
Epilepsy
Pediatrics
Temporal Lobe
Electroencephalography
Seizures
Hallucinations
Scalp
Magnetoencephalography
Auditory Cortex
Neocortex
Frontal Lobe
Fingers
Electrodes
Stroke
Head

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Neurology
  • Clinical Neurology

Cite this

Pediatric extratemporal epilepsy presenting with a complex auditory aura. / Clarke, Dave F.; Boop, Frederick; McGregor, Amy L.; Perkins, F. Frederick; Brewer, Vickie R.; Wheless, James.

In: Epileptic Disorders, Vol. 10, No. 2, 06.2008, p. 181-186.

Research output: Contribution to journalComment/debate

Clarke, Dave F. ; Boop, Frederick ; McGregor, Amy L. ; Perkins, F. Frederick ; Brewer, Vickie R. ; Wheless, James. / Pediatric extratemporal epilepsy presenting with a complex auditory aura. In: Epileptic Disorders. 2008 ; Vol. 10, No. 2. pp. 181-186.
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abstract = "Introduction. Ear plugging (placing fingers in or covering the ears) is a clinical seizure semiology that has been described as a response to an unformed, auditory hallucination localized to the superior temporal neocortex. The localizing value of ear plugging in more complex auditory hallucinations may have more involved circuitry. We report on one child, whose aura was a more complex auditory phenomenon, consisting of a door opening and closing, getting louder as the ictus persisted. Methods. This child presented, at four years of age, with brief episodes of ear plugging followed by an acute emotional change that persisted until surgical resection of a left mesial frontal lesion at 11 years of age. Scalp video-EEG, magnetic resource imaging, magnetoen- cephalography, and invasive video-EEG monitoring were carried out. Results. The scalp EEG changes always started after clinical onset. These were not localizing, and encompassed a wide field over the bi-frontal head regions, the left side predominant over the right. Intracranial video-EEG monitoring with subdural electrodes over both frontal and temporal regions localized the seizure-onset to the left mesial frontal lesion. The patient has remained seizure-free since the resection on June 28, 2006, approximately one and a half years ago. Conclusion. Ear plugging in response to simple auditory auras localize to the superior temporal gyrus. If the patient has more complex, formed auditory auras, not only may the secondary auditory areas in the temporal lobe be involved, but one has to entertain the possibility of ictal-onset from the frontal cortex. [Published with video sequences].",
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N2 - Introduction. Ear plugging (placing fingers in or covering the ears) is a clinical seizure semiology that has been described as a response to an unformed, auditory hallucination localized to the superior temporal neocortex. The localizing value of ear plugging in more complex auditory hallucinations may have more involved circuitry. We report on one child, whose aura was a more complex auditory phenomenon, consisting of a door opening and closing, getting louder as the ictus persisted. Methods. This child presented, at four years of age, with brief episodes of ear plugging followed by an acute emotional change that persisted until surgical resection of a left mesial frontal lesion at 11 years of age. Scalp video-EEG, magnetic resource imaging, magnetoen- cephalography, and invasive video-EEG monitoring were carried out. Results. The scalp EEG changes always started after clinical onset. These were not localizing, and encompassed a wide field over the bi-frontal head regions, the left side predominant over the right. Intracranial video-EEG monitoring with subdural electrodes over both frontal and temporal regions localized the seizure-onset to the left mesial frontal lesion. The patient has remained seizure-free since the resection on June 28, 2006, approximately one and a half years ago. Conclusion. Ear plugging in response to simple auditory auras localize to the superior temporal gyrus. If the patient has more complex, formed auditory auras, not only may the secondary auditory areas in the temporal lobe be involved, but one has to entertain the possibility of ictal-onset from the frontal cortex. [Published with video sequences].

AB - Introduction. Ear plugging (placing fingers in or covering the ears) is a clinical seizure semiology that has been described as a response to an unformed, auditory hallucination localized to the superior temporal neocortex. The localizing value of ear plugging in more complex auditory hallucinations may have more involved circuitry. We report on one child, whose aura was a more complex auditory phenomenon, consisting of a door opening and closing, getting louder as the ictus persisted. Methods. This child presented, at four years of age, with brief episodes of ear plugging followed by an acute emotional change that persisted until surgical resection of a left mesial frontal lesion at 11 years of age. Scalp video-EEG, magnetic resource imaging, magnetoen- cephalography, and invasive video-EEG monitoring were carried out. Results. The scalp EEG changes always started after clinical onset. These were not localizing, and encompassed a wide field over the bi-frontal head regions, the left side predominant over the right. Intracranial video-EEG monitoring with subdural electrodes over both frontal and temporal regions localized the seizure-onset to the left mesial frontal lesion. The patient has remained seizure-free since the resection on June 28, 2006, approximately one and a half years ago. Conclusion. Ear plugging in response to simple auditory auras localize to the superior temporal gyrus. If the patient has more complex, formed auditory auras, not only may the secondary auditory areas in the temporal lobe be involved, but one has to entertain the possibility of ictal-onset from the frontal cortex. [Published with video sequences].

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