Pharyngeal dysesthesias as an aura in temporal lobe epilepsy associated with amygdalar pathology

Purpose: Pharyngeal dysesthetic auras are typically described with centrote mporal and opercular seizure-onset localizations. In this report we describ e the fourth case in literature with temporal lobe seizures, apparently sec ondary to an amygdalar lesion on magnetic resonance imaging (MRI), presenti ng with prominent pharyngeal dysesthesias as the initial. or only, seizure manifestation. Methods: Because of diagnostic uncertainty regarding the nature of the phar yngeal sensations, our case underwent prolonged extracranial video-EEG moni toring. Results: Video-EEG information documented the epileptic origin of the dyses thesias and was concordant with the side and location of the amygdalar lesi on. Conclusions: Pharyngeal dysesthetic auras may be produced by epileptic acti vity originating from the amygdala, and perhaps other mediotemporal structu res. The underlying topography of this aura is not known with certainty, an d it may reflect seizure spread from the amygdala and adjacent areas to the closely interconnected insular and opercular cortex, whose secondary activ ation could elicit similar sensations.