[Info] Invaluable article on Simple Partials (auras)

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qtowngirl

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The Value of Auras

by John Stern, MD

Sometimes, and not infrequently, the diagnosis of epilepsy is entirely based on the descriptions provided by the patient and witnesses. Diagnostic testing, including both EEG and MRI, can fail to help, and an accounting of the episodes is the basis for the diagnosis. In the telling, the details are critical and the details of auras can be invaluable. To some, auras are a peripheral aspect of the diagnosis; however, this seems to be an underappreciation. Auras can distinguish seizures from other causes for loss of consciousness. Auras can identify the seizure-onset as focal (not generalized) and they can indicate a possible localization. Auras also can be fascinating hints at the potential for human perception beyond conventional experience.

Synesthethetic auras bridge the relatable and the unrelatable. Synesthesias most often occur as isolated phenomena that are not associated with epilepsy or other neurologic abnormality. They are the combining of two, independent sensory modalities, such as vision and hearing. Associating specific colors with specific musical notes is a classic synesthesia. When auras have synesthetic aspects, the component senses may help localize the aura. One example is a patient who described an aura during which whatever object she happened to be seeing would become heavier on one side. The object would not move or change form, but it would seem unbalanced with a shift of its center of gravity. The patient visually perceived weight, which is a tactile sensation, and her epileptogenic zone was found to be parietal-occipital association cortex, which makes sense considering the functions subserved by these cerebral regions. Another patient described fear behind his eyes, that is, he had a somatotopic localization for an emotion. He had a neocortical epileptogenic zone that spanned the Sylvian region. Potentially valuable clinical information can be gained by encouraging patients to speak openly about their auras. With greater detail, the description may be localizing or help avoid a false localization based on a misunderstanding.

Arguably, everyone who regularly interviews patients with auras often encounters patients who have difficulty giving a detailed description of the aura. Often, the patient is clear about having a stereotyped experience at the seizure onset, but pauses and falters when asked to describe it. Many patients can articulate descriptions of epigastric rising (or falling), primary sensory hallucinations, déjà vu, and fear, and these auras are relatable to normal experiences. However, many other patients cannot find a description and instead repeat knowing it when it happens and simply say that the experience is indescribable. Even the guidance by offering specific questions, such as whether the experience is an emotion, a thought, or a sensation somewhere on or in the body often does not help. This is different from fainting, a common alternative diagnosis when evaluating the new onset seizure. The onset of a faint is not nearly as indescribable, and the association of the difficulty in description with seizures is somewhat helpful. My estimation for whether the episode was a seizure increases when an otherwise articulate person has considerable difficulty communicating the experience of the onset. My estimation also increases when the patient gestures with a movement of the hand vertically across the chest. This seems to be the non-verbal correlate to the reported epigastric experience and akin to Levine’s sign of a fist across the chest that is commonly used to non-verbally communicate the experience of angina. Sometimes gestures supplant words and this may be due to the patient’s recognition that the words are not working.

Words work by referencing something that is commonly known or experienced. Specific words come to exist only when people need a way to reference something. My sense is that the indescribable nature of auras is partly due to the experience being uniquely individual. The experience does not exist in the world shared with others. How could a word exist for an experience that is due to one person’s abnormal neuronal activity? As such, perhaps auras are often indescribable because words do not exist for the experiences and not because patients are lacking in descriptive ability. Sometimes patients provide descriptions that are impressively detailed but still not communicating a relatable experience. These descriptions are seemingly metaphoric and using words beyond their immediate definitions. This may be as simple as a recent, highly educated patient’s description of an aura as the experience of ”tilting.” When questioned in detail, “tilt” here was not intended to indicate any change in position or orientation with regard to gravity. Ultimately, the patient said that she meant “tilt” to mean that her experience of the world was changed in a way that the word “tilt” came to mind even if the definition of tilt did not apply. The world was “off.” A more intriguing description, from another patient, is feeling during the auras that she was perched on her own lower lip, facing into her mouth, and crying out loudly. This congers an image that is impossible but it still is an exact experience for the patient. It is a metaphoric expression for an experience that cannot be described any other way.

The experiences during auras are due to cerebral dysfunction and they demonstrate the brain’s capacity to generate experiences beyond what is conceivable in a normally restricted, external world experience. Discussing the details of these experiences with patients can lead to a more accurate diagnosis and also can help build a better relationship of understanding between the clinician and patient, who may feel that the experience is too indescribable to share. In building this understanding, the clinician also gets the opportunity to hear examples of the brain’s tremendous potential for creating experiences.
 
Thanks! I could not believe how much he nailed it on the head.

As for the link, I tried once a little while ago with another piece and the site wouldn't let me post a link, said I hadn't been a member long enough, so lastnight I just tried pasting. But now that I've 'joined the party' I bet I could, so I'll try something else I have that's really interesting and put it in the library too. Good Day to everyone...
 
Sorry to resurrect a dead thread but this article is amazing. The best thing about it is that it makes me feel normal in that I've not been able to describe auras and when I try, my doctor only looks at me confused because that, too, is the appropriate response.

During the worst, untreated phase of my epilepsy the only way I could describe what was happening was to say that every sound became furious. Everything I heard had a certain hostile tone. I have always thought that those experiences had been really abnormal and possibly unrelated to my epilepsy (since nobody else I came across had described anything similar.) During that time, I also had a far happier seizure. I was 20 and living in a cottage that had the sort of garden you'd expect to see in a fairy tale. One evening I came home and saw huge purple and pink bubbles floating all over the place, above the ground. Years later, I was sitting in my bedroom with my windows and doors closed when I saw the curtain blow outwards and the cupboard slam shut, but there had been no way that wind could have come in from anywhere. Most often, I feel as though gravity has changed and is pulling me to one side. If I am walking, I walk to the right--I cannot walk straight. If I overcompensate to get back to the side of the road, the gravity sometimes changes to the left. Well, this is the first time I've been able to say these things without feeling like an idiot. Thanks for posting the article.
 
very welcome kirsten, i thought so too. everyone's partials are so different, unique to all of us, and there really is no way to make someone understand. when i found this i was blown away at what a good job this doctor did in doing so :)
 
Wow, explaines seeing things, and seeing them as distortions as well. had one experience driving where I thought I saw gaffiti on the wall (Dead Mans Curve) that wasnt there the day before, it made me upset that someone had defaced the wall, any hoot, I was trying to get over into 2 far left lane (on the highway) , I glanced out of both rear and side mirror, saw nothing in the lane that I wanted and preceded to get over when suddenly the graffiti was supper close, I took a second look and realized that it was not written on the wall but on the side of a truck driving sidelong with me! Oh chit chat, I almost drove right into a truck. I totally freeked out of course. My eyes made the truck graffiti appear further way than what it actually was. God is good. Needless to say, I stayed right where I was unto it was time to get off at my exit. I may have posted th is once before, not sure?
 
Thank you for helping me to understand auras better. I now believe the weakness that I feel in my leg and arm is actually an aura. It the past I only thought the phantom odors and possibly the strange tastes I experience were auras. When I am experiencing the weakness it is only something I can perceive. If I have a physical exam while experiencing the weakness the doctors are not able to detect it. I had a stroke 3 years ago and the doctor told me last week that the area of the brain affected by the stroke is the area of the brain that affects perception. Things are finally starting to make sense to me. :)
 
I am so freaked out with the epigastric seizures I have been experiencing for the past 2 yrs. The doc does not REALLY understand my description but has put me on Valproic Acid as a precaution....1200mg per day...2 in am and 3 at bedtime. He is trying to get me a referral to a neurologist, as I had an abnormal eeg.
These types of seizures are horrid. With me they only seem to happen every month or 2 and I have no idea what triggers them. They usually start of with butterflies in the tummy and I can hear a voice in my head saying "here we go" or "here it comes". After the rising I have pain in my stomach and sometimes feel like retching..Does ANYONE have similar symptoms ????
 
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