An Overview of Seizure Aura

The aural phase of a seizure is sometimes described as the pre-ictal stage. It can occur seconds, minutes or up to an hour before a seizure. Some people experience seizure aura symptoms such as visual changes or nausea prior to having a seizure. 

The effects of a seizure aura may resemble the subsequent ictal phase (also described as the convulsive phase) of the seizure, but that is not always the case.

A seizure aura is believed to be caused by a change in brain activity that precedes a seizure. If you have recurrent seizures due to epilepsy, you may begin to notice a pattern of aura symptoms. It can be helpful to discuss your aura with your healthcare provider. While it is often difficult to prevent a seizure from progressing once the aura phase has begun, you may be able to take action to avoid injuries or harmful effects when you feel that you are having a seizure aura. 

Symptoms 

If you or your child has epilepsy, it’s important to know that not everyone experiences an aura phase prior to having a seizure. This phase can begin shortly before a seizure and it can have a duration between a few seconds to a few minutes—and rarely lasts for an hour or longer.

If you experience a seizure aura prior to some or all of your seizures, you are likely to have the same type of aura every time. The symptoms can involve physical sensations, emotional perceptions, or muscle movements.

Aura symptoms can include: 

• Tiredness
• Sleepiness
• Strong emotions—such as sadness, anxiety, or fear 
• Feeling detached from reality 
• Distorted vision 
• Visual effects—like seeing zigzag lines 
• Smelling a strange or unexpected odor 
• Deja vu 
• Dizziness, lightheadedness, or a sense of spinning 
• Gastrointestinal problems like nausea, stomachaches, vomiting, or diarrhea
• Feeling unusually hot or cold 
• Odd tastes in your mouth
• Repetitive face, arm, or leg movements (that are not exactly like the movements of your seizures)
• Tingling or other unexplained sensations 
• Altered sound perception 
• Hearing sounds that are not present, such as beeping or ringing in your ears 
• Usual dreams 

Most of the time, people who have epilepsy are aware of their seizure aura. If you experience an aura prior to your seizures, you may begin to recognize a recurrent pattern, such as how long your aura lasts before your seizure begins. 

Causes

A seizure is caused by abnormal brain activity. An aura is often described as the beginning of a seizure. A seizure aura is associated with changes in brain activity that can make you see, feel, hear, smell, or taste things that are not aligned with your actual surroundings.

The brain activity that occurs during an aura can produce a variety of sensations that are not really reflective of what is going on around you. Your seizure aura is expected to correspond to the area of the brain where your seizure begins.

For example:

• Seizures that originate in the temporal lobe (an area of the brain near the ears) are often preceded by auras consisting of usual psychic experiences.
• Seizures that originate the frontal lobe (the front portion of the brain) may begin with auras that manifest with involuntary physical movements.
• Seizures that originate in the parietal lobe (located at the top of the brain) may be preceded by auras that consist of sensory changes—such as unexplained usual taste or arm tingling. 

Diagnosis 

You may know that you are having an aura when you notice recurrent symptoms that tend to occur prior to your seizures. Sometimes these episodes can be detected with an electroencephalogram (EEG). However, diagnostic tests are not especially useful when it comes to identifying a seizure aura because you can experience a seizure within seconds of having an aura.

An aura that occurs prior to a seizure may be associated with the seizure type. This can help in diagnosing your seizure type and in formulating your treatment plan. 

Electroencephalogram (EEG) 

During a seizure aura, there are changes in brain activity that may be detected with an EEG. This is a non-invasive diagnostic test that is used to assess changes in consciousness. It is often used in the evaluation of seizures. 

An EEG is done in a diagnostic testing area in the hospital or clinic. You can have this test as an outpatient and go home the same day. You may also have the test in the hospital if you are being hospitalized for a medical issue. 

During an EEG, you would have electrical leads placed on your scalp. The leads are shaped like metal coins. They can detect the electrical activity that occurs in the brain, resulting in the production of a computer-generated brain wave pattern.

During a seizure aura, the brain wave pattern is very similar to the brain wave pattern of the subsequent seizure. Sophisticated algorithms can help differentiate between the electrical rhythm of an aura and that of a seizure, but these methods are primarily used in research and are not especially practical in managing your seizures.

Blood Tests

Researchers have been able to identify some chemical changes in the body that occur during a seizure aura, but these tests are not consistent and are not typically helpful in managing epilepsy.

Treatment and Coping

If you have epilepsy, there are many anti-epilepsy medications that can be used to prevent your seizures. In general, seizure aura is not managed separately from or differently than a seizure. There are no medications specifically used for treating a seizure aura. 

Sometimes, however, it may be possible to use a short-acting anti-seizure medication to prevent a seizure after an aura starts. This is not a common strategy because a seizure can start within a very short time of the beginning of an aura—even before you have the chance to take anti-epilepsy medication and before any medication would be expected to take effect. 

Epilepsy Service Dogs

Sometimes, an epilepsy service dog can be trained to detect a seizure aura. While it may be too late to prevent a seizure if your dog alerts you that you are having an aura, you may have time to get to a safe area if your dog alerts you that an aura is happening. 

A Word From Verywell

The aural phase of a seizure is a sign that a seizure is about to happen. However, it is not a reliable sign because sometimes seizures occur even without a preceding aura. If you or your child has epilepsy, it can help to try to recognize patterns so you can adjust your activity to maximize safety if necessary.