The localizing and lateralizing value of painful epileptic auras in 25 patients with focal epilepsy were studied at the Cleveland Clinic, OH. In a group of 604 consecutive cases of focal epilepsies reviewed, 25 had painful auras (4.1%). Age at seizure onset was mainly in childhood (median 7 years, range 1 to 42). Pain was associated with temporal (TLE, 14 cases), frontal (FLE, 6), parieto-occipital (POLE, 2), and perirolandic (PRE, 3) lobe epilepsies. The auras were localized to the abdomen (painful abdominal) in 10 (most with TLE), head and face (painful cephalic) in 11, and extremities (painful somatosensory) in 6. The greatest number of painful auras occurred with TLE, while the greatest frequency was with PRE (10%). Although the number of painful abdominal auras was highest in TLE (6/119, 5%), the frequency was highest in FLE (4/8, 50%). Somatosensory painful auras with PRE were contralateral to the epileptic focus, but with TLE they were sometimes ipsilateral. Painful epileptic auras may resolve after focal cortical resection, which suggests a cortical representation for pain. 
COMMENT. An ictal origin for pain has been described infrequently, originally by Gowers in 1901 and later by Lennox and Cobb in 1933. Among 750 patients reporting auras, 2.8% had painful sensations, vs 6% with numbness and 5.1% paresthesias . In the present series, the greatest number of cases were associated with temporal lobe epilepsy.