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Epilepsia, 45(8):982–984, 2004
Blackwell Publishing, Inc.

C 2004 International League Against Epilepsy
Prescience as an Aura of Temporal Lobe Epilepsy
R. Mark Sadler and Susan Rahey
QEII Health Sciences Centre, Halifax, Nova Scotia
Summary: Purpose: A patient with a distinct aura of prescience
as a manifestation of temporal lobe epilepsy was encountered.
The experience prompted a review of this ictal phenomenon
among patients attending a tertiary care epilepsy outpatient
clinic.
Methods: A computer epilepsy database was searched for pa-
tients with simple partial sensory seizures and complex partial
seizures with auras. Identified patients had charts reviewed for
details of the auras; patients were contacted and asked to pro-
vide written descriptions of their experiences. Literature searches
(PubMed) were done by using the terms “precognition” or “pre-
science” and “seizures” or “epilepsy.” Standard comprehensive
epilepsy textbooks were reviewed.
A number of subjective phenomena compose the psychic
auras of temporal lobe–originating seizures (1). A patient
was encountered whose seizures begin with a profound
sense of being able to predict imminent events in her
environment. This experience fulfills the definitions of
precognition [“antecedent cognition or knowledge; fore-
knowledge” (2)] or prescience [“knowledge of events be-
fore they happen” (2)]. These experiences can be distin-
guished from the more common psychic phenomenon of
déjà vu (“an illusory feeling of having previously expe-
rienced a present situation”) (2). The unusual nature of
our patient’s description prompted a review of the local
experience and the literature.
METHODS
A computerized database from the Epilepsy Clinic at
the Queen Elizabeth II Health Sciences Centre was used
to identify two groups of patients: (a) those with simple
partial sensory seizures, and (b) those with complex par-
tial seizures with auras (simple partial onset seizures). The
clinic charts of all identified patients were reviewed. Pa-
tients with ictal prescience were contacted and asked to
Accepted April 25, 2004.
Address correspondence and reprint requests to Dr. R.M. Sadler at
QEII Health Sciences Centre, 1796 Summer Street, Room 3829, Halifax,
Nova Scotia B3H 3A7, Canada. E-mail: rsadler@dal.ca
982
Results: The charts of 218 patients were reviewed from 927
in the database; three had prescience as an ictal feature. The pa-
tients’ descriptions were very similar in all cases (a profound
sense of “knowing” what was going to happen in their environ-
ment in the immediate future). The experience was distinct from
déjà vu and other psychic experiences. All patients probably have
temporal lobe epilepsy. Only one other description of prescience
as an ictal feature was found in the literature.
Conclusions: Prescience can occur as an ictal feature of
temporal lobe epilepsy and represents a previously underre-
ported psychic phenomenon. The potential lateralizing value
of this symptom is yet to be determined. Key Words:
Temporal lobe epilepsy—Complex partial seizures—Auras—
Prescience—Precognition.
provide written descriptions of their seizure experiences
to supplement the chart data.
A literature search (PubMed) using the search terms
“precognition” or “prescience” combined with “seizures”
or “epilepsy” was performed. Standard comprehensive
epilepsy textbooks (1,3–9) were reviewed for descriptions
of psychic or experiential auras associated with temporal
lobe epilepsy and complex partial seizures.
RESULTS
Two hundred eighteen patients with simple partial sen-
sory seizures or complex partial seizures with auras were
identified from the database of 927 epilepsy patients.
Three patients were identified with prescience as an
ictal feature. The patients’ clinical features and results of
investigations are summarized in Table 1. The descriptions
of the ictal phenomena are as follows:
Patient 1 (a thoroughly right-handed sales clerk in a mu-
sic store): “They start with a rising feeling in my stomach
and a feeling of déjà vu, by which I mean that it feels like
all of this has happened before. At the same time I have a
different feeling that I know what is going to happen next.
For example, one day I was talking to a customer in my
store, and I had the profound sense that I knew what he
was going to say next. On other occasions, I have looked
at a customer just as the seizure is starting, and I have a

PRESCIENCE: AURA OF TEMPORAL LOBE EPILEPSY
TABLE 1. Characteristics of patients with prescience
Age (yr); Age epilepsy Seizure types;
Patient Gender onset (yr) frequency
1 30; F 17 SP 2/mo
SP → CP 4/mo
2 43; F 14 SP 5/mo
SP → CP 2/yr
◦
2 Gen T-C. Lifetime, 2
3 34; M 14 SP 6/yr
◦
2 Gen T-C. Lifetime, 5
◦
SP, simple partial; CP, complex partial; 2 Gen T-C, secondarily generalized tonic–clonic.
feeling that I know which compact disc he is going to go
over and pick up.” Thirty seconds later, she has a loss of
contact with her environment and is amnestic for the next
5 min.
Eight seizures were recorded during scalp video-EEG
telemetry; five seizures were left temporal, and three, right
temporal onset. The patient described prescience with the
right temporal–originating seizures in contradistinction to
the left-side–originating seizures that had only rising epi-
gastric features.
Patient 2 (a thoroughly right-handed nurse): “In the past,
a wave would sweep over me, and I had the distinct sensa-
tion that I knew what was going to happen in my immediate
environment. Over the years, this sensation has changed;
I have a déjà vu experience that occurs together with a
feeling that I know what movements my body will make
before it actually moves; it is like I know that my arm will
move before it does.”
Patient 3 (a thoroughly right-handed businessman): “I
am fully aware of myself. For example, I can be sitting in
my office talking to a customer when this feeling begins,
and as it starts, I say to myself ‘Here we go again.’ As I sit
there, I get a sick-to-my-stomach feeling and could swear
that I know what they are going to say and an even stronger
feeling about their movements, such as I know that they
are going to get out of the chair. During this entire time, I
am completely aware of what is going on and can keep my
composure. It is very hard to put into words because I know
I cannot see the future.” When specifically asked about a
déjà vu sensation, the patient denied that his experience
has this quality.
DISCUSSION
The literature search failed to find any publication
specifically addressing precognition or prescience as an
ictal feature.
A number of subjective psychic phenomena (most com-
monly associated with temporal lobe epilepsy) have been
described. Fish (1) categorized these sensory experiences
as perceptual hallucinations and illusions (visual, audi-
tory, olfactory), mnemonic (déjà vu, jamais vu, mem-
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983
Interictal Ictal
Etiology EEG EEG MRI
Unknown Bitemporal 3 Right temporal Small right fornix
spikes 5 Left temporal
Unknown Bitemporal None recorded Left
spikes mesial temporal sclerosis
Unknown Nonspecific None recorded Normal
temporal theta/delta
ory recall, memory gaps/amnesia), emotional (fear, sad-
ness, pleasure, sexual emotion, emotional distress, anger),
and other [change in personality, depersonalization, feel-
ing of presence (i.e., as if someone is nearby), forced
thinking, and distortion of body image]. Several standard
epilepsy textbooks (1,3–9) do not describe any ictal fea-
tures similar to our patients.’ Other publications address-
ing the neuroanatomic correlates of psychic or experien-
tial phenomena do not contain descriptions of prescience
(10–17).
Perusal of the literature on psychic and experiential
epilepsy phenomena uncovered a single case (patient 4)
reported by Gloor et al. (18), who had virtually identical
features to those described by our patients:
The patient has a sudden unpleasant churning sensation
in his stomach, a pounding headache, and a sudden feel-
ing of déjà vu associated with the illusion that he could
predict what would happen next . . . . The patient pressed
the seizure button and a nurse came in with a flashlight.
She asked him whether the attack was like the preceding
ones, to which he replied: “Yes, and you are coming in
right now, it is all part of it; I mean as soon as I pressed it
(i.e., the seizure button), I almost did not, because I knew
you were going to come in. It is as if I were reliving all
that is happening now. I just knew that you were going
to come in with the flashlight on” (18). This patient, with
bitemporal epilepsy, had prescience as a feature of right
temporal, but not left, originating seizures and therefore
is identical to our patient 1 in these respects.
Precognition or prescience is an uncommon seizure
manifestation (only three of 927 patients in a tertiary care
epilepsy clinic). It has certainly been underreported, as we
found three patients in this clinic but only one description
in the literature. Some investigators may have overlooked
the details of patients’ descriptions or interpreted a de-
scription of prescience synonymously with déjà vu. For
example, Bancaud et al. (16) cited Jackson’s interpreta-
tion of the “dreamy state” as including “both a feeling
of reminiscence—that current experience is a repetition
of something already lived—and that the actions about to
happen can be predicted (now termed déjà vu).” Palmini
and Gloor (15) proposed a “strict definition” of déjà vu
Epilepsia, Vol. 45, No. 8, 2004

984 R. M. SADLER AND S. RAHEY
that requires the patient only to be aware of the illusory
nature of the feeling of familiarity.
Prescience is likely closely allied with déjà vu but is sub-
jectively different. Patient 1 experiences both déjà vu and
prescience but can distinguish these experiences. Patient 2
had prescience in the early years of her seizures, but over
time, this experience has evolved to include classic déjà
vu. Patient 3 has prescience alone, understands the classic
definition of déjà vu, but denies that his ictal experience is
one of familiarity. Patient 1 has bitemporal lobe epilepsy
confirmed by video-EEG telemetry; patient 2 has strong
supporting evidence for temporal lobe epilepsy (bitem-
poral interictal EEG spikes and mesial temporal sclero-
sis on magnetic resonance imaging); and patient 3 has a
clinical picture compatible with temporal lobe epilepsy.
We hypothesize that prescience can be a symptom of
temporal lobe–originating seizures. Déjà vu auras have
a tendency to arise from the right temporal lobe (15),
and further studies correlating prescience with the side
of ictal onset may support the lateralizing value of this
symptom.
Acknowledgment: We are grateful for the expert secretarial
assistance provided by Ms. Dawnelda Wight.
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