Bret S. Stetka, MD; Robert L. Glover, MD


May 19, 2015

Editor's Note: At a poster session at the 67th American Academy of Neurology Annual Meeting, Medscape spoke with Robert L. Glover, MD, neurology resident at Albert Einstein College of Medicine, Bronx, New York, about a case report suggesting that orgasmic auras could be a red flag for brain pathology.

Medscape: Can you give us some background on your poster[1]?

Dr Glover: Our study was a case report detailing a rare form of epilepsy. We hope to draw attention to a condition not routinely seen, even by neurologists.

Medscape: Tell us about the patient.

Dr Glover: We described a 56-year-old man who presented to the emergency department with a first lifetime complex partial seizure that spontaneously resolved. On workup he was found to have a right-sided temporal lobe brain mass that was later identified as a WHO grade II oligodendroglioma, based on open biopsy results.

When we elicited more history from him, he told us about unprovoked sexual arousal that he was experiencing a few times daily without ejaculation. He was diagnosed with orgasmic auras and started on antiseizure medication with very good results.

About 2.5 years later, however, his auras recurred. He was sent for repeat MRI imaging at that time and found to have new growth of the tumor, which had previously been stable. He was placed on the chemotherapy agent temozolomide and his follow-up brain imaging showed tumor shrinkage. His auras ceased.

Medscape: Has orgasmic aura previously been associated with brain tumors? How about in association with other conditions?

Dr Glover: Yes, there have been descriptions of orgasmic auras being associated with brain tumors previously. What seems to be increasingly clear is that patients who develop epilepsy from a right-sided seizure focus, probably in the amygdala, are the most likely to suffer from this condition. The actual cause of epilepsy can be quite variable.

Medscape: What are the clinical implications of your findings?

Dr Glover: We hope that our findings increase awareness about this condition and the need for physicians to take this patient complaint seriously, as bizarre as it may seem. It can be quite disabling! The association between seizures and new tumor growth is controversial, but in our patient, in fact it was a harbinger of something serious.


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