Temporal lobe epilepsy

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 25, 2016
StartDiseasesTemporal lobe epilepsy

Epilepsy affects 48 out of every 100,000 people in the United States making it the fourth most common neurological disorder behind migraines, strokes, and Alzheimer’s disease. Young children and older adults are more likely to be diagnosed with epilepsy than any other age group. Temporal lobe epilepsy is one of over 40 known types of epilepsy.

Contents

Definition & Facts

The brain is divided into two cerebral hemispheres, and each hemisphere has a frontal lobe, parietal lobe, occipital lobe, and a temporal lobe. The temporal lobe is located on the bottom middle part of the brain behind the temples, and it’s primarily responsible for auditory processing, speech, and language comprehension.

Other temporal lobe functions include memory, facial recognition, emotional responses, and visual perception. Chronic and unprovoked seizures with or without the loss of awareness that originate in the temporal lobe region of the brain are temporal lobe seizures.

Symptoms & Complaints

When temporal lobe seizures occur, a person may feel an unusual sensation known as an aura. Some people believe an aura to be a warning sign, but it’s actually the start of a partial seizure. There are two types of auras - experiential and sensory. Someone with an experiential aura before having a temporal lobe seizure may experience events such as:

Someone who has a sensory aura before a temporal lobe seizure may experience sensations such as:

A partial seizure may or may not progress to a more advanced seizure, which is known as complex partial seizures and secondarily generalized tonic-clonic seizures (grand mal seizure). Complex partial seizures can last up to two minutes and are characterized by motionless staring, unusual speech or behaviors, and unusual movement in the hands and mouth. A generalized tonic-clonic seizure is when the body and limbs stiffen then go into convulsions.

After a seizure, the person will be confused, have difficulty speaking and have no recollection of the seizure. After repeated seizures over the long term, the hippocampus, which is responsible for memory and learning, shrinks causing the loss of brain cells and memory problems.

Causes

It’s not known what exactly causes temporal lobe seizures, but they usually begin before a person reaches 20 years of age. Medical professionals have identified a number of factors that may contribute to causing this kind of seizure. Some of these factors include:

Diagnosis & Tests

Temporal lobe epilepsy can be treated, but getting the proper diagnosis requires a person to be diligent about documenting their or their loved one’s symptoms. If possible, a person should try to take a video of their loved one having a seizure so that the family doctor can view what is happening. They should also make a list of all of the medications being taken and write down questions they would like to ask the family doctor.

Once the family doctor has this information, they will make a referral to a neurologist who specializes in epileptic seizures. The neurologist will conduct a number of neurological examinations on the patient that will check the patient’s muscle tone and strength, coordination and balance, reflexes, posture, and function of the sensory system. Memory, thinking, and judgment tests will be performed to see if any damage has been done in these areas.

Blood tests can be used to detect triggers that cause the seizures. There are also three in-depth tests a neurologist can use to detect brain abnormalities. An electroencephalogram checks the brain’s electrical activity so that the neurologist can see brain wave patterns that are typical of a person with epilepsy. Magnetic resonance imaging (MRI)s checks for abnormalities in the brain’s structure. Like an MRI, a single-photon emission computed tomography is a type of neuroimaging that is given to determine where the seizure originates.

Treatment & Therapy

Medication and surgery are the two most common methods for treating temporal lobe epilepsy, but in some cases, diet can also be used as a treatment. There are several antiepileptic drugs on the market, including phenytoin, valproate, gabapentin, lamotrigine, and lacosamide. These medications can have side effects like dizziness, unexplained weight gain, fatigue, and they may interfere with other medications a person may be taking.

Medications alone may not be effective enough to control seizures in some people, so surgery would have to be taken into consideration. Surgery has been shown to reduce or eliminate seizures, but surgery can lead to other neurological problems. Surgery may not eliminate the need for medication, but a person may be able to reduce the amount of medication that they need to take to prevent seizures. If medications are ineffective, and surgery doesn’t eliminate the recurrence of seizures, then deep brain stimulation and vagus nerve stimulation can be used to reduce the occurrence of seizures.

In some children with temporal lobe epilepsy, a low-carbohydrate, high-fat ketogenic diet has been shown to reduce the number of seizures. Over time, temporal lobe seizures affect memory and speech, so cognitive therapy and speech therapy may be recommended to help a person maintain and improve their memory and speech.

Prevention & Prophylaxis

There is nothing that can be done to prevent a temporal lobe seizure from happening, but up to a third of children who suffer from this will grow out of this condition. Seizures can be dangerous if a person is involved in certain activities like driving a car or heavy equipment, swimming or bathing, or working while standing on a ladder.

States have licensing restrictions for drivers who suffer from seizures, and accidents can result in injury or death if a person goes into a seizure. A medical alert bracelet should be worn by a person suffering from seizures so that if a seizure occurs, other will know who to contact.