Temporal lobe epilepsy

Temporal lobe epilepsy is the most common form of focal epilepsy, with 6 out of 10 focal epilepsy patients having temporal lobe epilepsy.

Often described as a sense of deja vu, joy, or fear, a seizure in temporal lobe epilepsy is often accompanied by impaired awareness.

Let’s understand the effects of this type of epilepsy, the types of seizures patients can experience, its risk factors, and the best treatment for temporal lobe epilepsy in India.

What is temporal lobe epilepsy?

Temporal lobe epilepsy (TLE) or temporal lobe seizures begin in the temporal lobes of the brain.

We have two temporal lobes, one of either side of our head behind the temples, and in alignment with our eyes. It is the part of the brain responsible for processing emotions as well as for short term memory. It also interprets sounds and vision, controls speech and language, as well as some automatic/unconscious responses like –

Thirst
Hunger
Sexual arousal
Fight or flight sentiments

Types of temporal lobe epilepsy

There are two types of temporal lobe epilepsy. They are –

Mesial temporal lobe epilepsy (MTLE)

Involving the medial (middle) or internal parts of the temporal lobe, this type of TLE causes seizures that typically begin in the hippocampus and/or its surrounding area. 8 out 10 patients with TLE have MTLE

MTLE usually manifests between the age of 10 years and 20 years, however there have been cases where the epilepsy begins at even younger age. It is usually accompanied by a fever, or can be a result of injury sustained by the brain in early years.

MTLE shows up in an MRI in the form of abnormal scarring or hardening of the temporal lobe. This condition is typically called hippocampus sclerosis. The hippocampus appears to have shrunk on one or both sides.

Neocortical or lateral temporal lobe epilepsy

This type of TLE brings about seizures that start in the outer section of the temporal lobe. It is a rare form of temporal lobe epilepsy, caused due to a genetic defect or lesions like a tumor, blood vessel abnormality, birth defect, or defects in the temporal lobe.

Types and symptoms of seizures in temporal lobe epilepsy

Temporal lobe seizures are accompanied by impaired awareness. These are focal seizures that include focal aware seizures and focal impaired awareness seizures.

What are focal seizures?

These seizures are caused by abnormal activity in just one part/area of the brain. Individuals who experience focal seizures are diagnosed with focal epilepsy.

There are two types of focal seizures.

Focal seizures with impaired awareness : The patient may experience loss or change of consciousness. They may stare into space and not respond to the environment, or they may perform repetitive movements like walking in circles, chewing, swallowing, rubbing hands together, etc.

Symptoms of focal impaired awareness seizures

A patient experiencing focal impaired awareness seizures may have a fixed stare, be confused or unaware of their surroundings. These seizures can last 30 seconds to a couple of minutes.

Unusual posturing or movement in the arm is also typical of this seizure and is one of its earliest symptoms. This can help identify the beginning of a seizure and the patient and/or caregiver can take appropriate measures accordingly. Speech and language issues, and hearing a persistent buzzing sound are other common traits of focal impaired awareness seizures.

Focal seizures without loss of consciousness : The patient experiences a change of emotions or perceptions. Their five senses may do a complete 180 and perceive the environment and its stimuli different;y. Some patients have been known to experience a sense of deja vu, while some experience dizzying and flashing lights, or even a tingling sensation. Such seizures cause involuntary jerking of arm/leg.

Symptoms of focal aware seizures

Auras or simple partial seizures are the first symptoms of a temporal lobe seizure. Auras are often characterized by a sense of deja vu or butterflies in the stomach. Other auras include fear of impending doom, panic, anxiety, butterflies with nausea, rising sensation from stomach to chest or throat, etc. A heightened sense of smell is also associated with focal seizures and is usually caused by a lesion or tumor in the hippocampus.

Causes of temporal lobe epilepsy

Temporal lobe epilepsy can be caused by both known and unknown factors. Nearly 25% of TLE cases around the world have unknown causes. The remaining 75% may be caused by –

Injury to the brain (damaging temporal lobe)
Brain abnormalities at birth (malformation of cortical development, hamartomas, etc.)
Head trauma caused by accidents
Brain infections and diseases (meningitis, encephalitis, brain abscess, AIDS, etc.)
Brain abnormalities (tumor, stroke, dementia, abnormal blood vessels, etc.)
Genetic factors and mutations

Complications of temporal lobe epilepsy

Although not common, but TLE can be life-threatening. Below are some of the complications of temporal lobe epilepsy:

Status epilepticus

Seizures lasting anywhere between 5 mins and 30 mins, or seizures that occur close together without the patient recovering from them is medically termed as status epilepticus. This condition is a medical emergency and the patient requires immediate medical attention. If you’re a caregiver to a patient with TLE, be sure to time every seizure. At the first sign of status epilepticus, call an ambulance or drive straight to your nearest Emergency.

Sudden unexplained death in epilepsy (SUDEP)

1 in 1000 people with epilepsy are at risk of SUDEP. The cause of SUDEP is not known, however doctors believe that recurring seizures (that can’t be controlled) increase the risk. This is more common in adults than children.

How to diagnose temporal lobe epilepsy?

An electroencephalogram (EEG and Video EEG) is the most useful way to diagnose epileptic seizures. An EEG records the electrical activity in the brain, like unusual spikes or waves in electrical activity. These electrical activities show up as patterns in the EEG. Each pattern corresponds to a type of epilepsy.

The following tests may be recommended by your doctor to diagnose temporal lobe epilepsy –

MRI
CT
Video EEG
SPECT
Ictal SPECT
PET scan
MEG
SEEG
Neuropsychological testing

How to prevent temporal lobe epilepsy?

Preventing TLE may not be possible. However, you can reduce the frequency of temporal lobe seizures by –

Eating well balanced meals
Exercising regularly
Not skipping medication

You can also avoid or lower your chance of sustaining head trauma by –

Always wearing a seatbelt/helmet
Staying off ladders
Decluttering the floor of your homes
Not skipping steps on stairs
Not using your phone while walking/driving/riding

SOS

If you or your loved ones experience any of the following, please call an ambulance or visit the Emergency right away –

Seizures lasting longer than 5 minutes
Second seizure recurring within seconds/minutes of the first seizure
Severity of seizures increase
Seizures in pregnancy
New (not the usual) symptoms
Blisters or rash on skin after seizure
Not gaining consciousness after seizure
Slower than usual or incomplete recovery after seizure

Treatment for temporal lobe epilepsy

Depending on the frequency and symptoms of the temporal lobe seizures, doctors may prescribe:

Anti-seizure medications
Diet alterations
Surgery
Laser ablation (laser is directed at the lesions on the temporal lobe; using heat the lesions causing seizures are reduced)
Stereotactic surgery (radiation beams destroy seizure-causing lesions and malfunctioning nerve cells)
Electrical brain stimulators (vagus nerve stimulator, responsive neurostimulation device, deep-brain stimulation device)

Plexus Epilepsy Clinic

Plexus offers the best temporal lobe epilepsy treatment plans based on your unique condition, age, frequency of seizures, as well as other health factors and comorbidities. Our aim is to facilitate overall improvement by making structured routines a part of the patient’s daily life. This can go a long way in helping them better manage their condition.

Sometimes seizures still occur because patients can be resistant to certain anti-seizure medication. And this is why we offer other kinds of therapy for patients who are unable to benefit from medications and conventional treatments.

At the Plexus Epilepsy Clinic, we help you to –

Minimize your need for anti-seizure medications
Significantly improve your quality of life
Reduce associated costs of living with Epilepsy
Lower risk of complications and emergencies associated with seizures
Increase your chances of returning to work

Book an appointment with our epilepsy specialists today.

Call +91 89048 42087 | 080-2546 0886

080-2547 0886 | 080-2549 0886

FAQs

Is temporal lobe epilepsy serious?

Repeated temporal lobe seizures can gradually lead to loss of brain cells in the hippocampus. This can lead to impaired cognition and memory loss.

What triggers temporal lobe epilepsy?

Below are the causes of TLE –

Injury to the brain (damaging temporal lobe)
Brain abnormalities at birth (malformation of cortical development, hamartomas, etc.)
Head trauma caused by accidents
Brain infections and diseases (meningitis, encephalitis, brain abscess, AIDS, etc.)
Brain abnormalities (tumor, stroke, dementia, abnormal blood vessels, etc.)
Genetic factors and mutations

What age does temporal lobe epilepsy start?

Usually, symptoms of TLE manifest between 10 years and 20 years.

What is the most serious epilepsy?

Tonic-clonic seizure is the most serious type of epileptic seizures. It is characterized by a sudden loss of consciousness, accompanied by body stiffening, shaking, and jerking. It can cause loss of bladder control, or even cause the patient to bite their tongue.

Is temporal lobe epilepsy a mental illness?

No. Epilepsy is not a mental defect. It is a neurological condition that does not affect the patient’s cognitive or psychological capabilities.

Does temporal lobe epilepsy show on an MRI?

Lesions or scarring on the hippocampus can show on the MRI.

What foods should epileptics avoid?

Stimulants like caffeine (tea, coffee, chocolate), sugar, sweets, carbonated drinks, spices, excess salt, animal proteins, etc. can trigger epileptic seizures. Epilepsy patients must have these in moderation, and avoid them whenever possible.

Can temporal lobe epilepsy spread?

Temporal lobe seizures originate in the temporal lobe, but can spread to other parts of the brain. This is why if patients of TLE experience any new symptoms, they must alert their doctor immediately.