The authors studied the localizing or lateralizing value of painful epileptic auras in 25 patients with focal epilepsy. Painful auras were seen in 4.1% patients with focal epilepsy arising from temporal, frontal, perirolandic, or parieto-occipital regions. Abdominal pain was present in 5% of all abdominal auras in temporal lobe epilepsy and 50% of all abdominal auras in frontal lobe epilepsy. In perirolandic epilepsy, painful somatosensory auras were lateralized contralateral to the epileptic hemisphere but not consistently in temporal lobe epilepsy.