What is temporal lobe epilepsy?
The features of seizures beginning in the temporal lobe can be extremely varied, but certain patterns are common. There may be a mixture of different feelings, emotions, thoughts, and experiences, which may be familiar or completely foreign. In some cases, a series of old memories resurfaces. In others, the person may feel as if everything—including home and family—appears strange. Hallucinations of voices, music, people, smells, or tastes may occur. These features are called “auras” or “warnings.” They may last for just a few seconds, or may continue as long as a minute or two.
Experiences during temporal lobe seizures vary in intensity and quality. Sometimes the seizures are so mild that the person barely notices. In other cases, the person may be consumed with fright, intellectual fascination, or even pleasure.
The experiences and sensations that accompany these seizures are often impossible to describe, even for the most eloquent adult. And of course it is even more difficult to get an accurate picture of what people are feeling.
What are the types of temporal lobe epilepsy?
Temporal lobe epilepsy is the most common form of partial or localization related epilepsy. It accounts for approximately 60% of all patients with epilepsy. There are two types of temporal lobe epilepsy; one involves the medial or internal structures of the temporal lobe, while the second, called neocortical temporal lobe epilepsy, involves the outer portion of the temporal lobe. The most common version of these two is medial temporal lobe epilepsy.
Medial temporal lobe epilepsy often begins within a structure of the brain called the hippocampus or its surrounding structures. It accounts for almost 80% of all temporal lobe seizures.
Medial temporal lobe epilepsy is also considered a syndrome, which means that a lot of different conditions can result in medial temporal lobe epilepsy. Individuals who have medial temporal lobe epilepsy have seizures by definition of temporal lobe origin.
There are a lot of different older names for the seizures that occur in temporal lobe epilepsy, including, “psychomotor seizures”, “limbic seizures”, and “temporal lobe seizures.” The modern name for these seizures is “complex partial,” if there is loss of awareness or “simple partial” if awareness is retained.
While medial temporal lobe epilepsy is a very common form of epilepsy, it is also frequently resistant to medications and associated with a particular finding on an MRI. This finding is called hippocampal sclerosis (sclerosis means hardening) and it makes this a challenge to treat both medically and oftentimes surgical therapy is the best option for these individuals.
When does temporal lobe epilepsy usually develop?
Medial temporal lobe epilepsy usually begins at the end of a first or second decade in most people, following either a seizure with fever or an early injury to the brain. In women, hormonal influences during their menstrual cycle and ovulation may lead to reports of increased seizures during their menstrual cycle.
(That's what did it for me)
What type of seizures are seen?
Seizures in temporal lobe epilepsy include simple partial seizures, such as auras, and focal seizures with complex impairment in consciousness, otherwise known as complex partial seizures.
The most common auras are déjà-vu experiences or some gastrointestinal upset. Feelings of fear, panic, anxiety or a feeling of a rising epigastric sensation or butterflies with nausea are also other ways in which auras present in medial temporal lobe epilepsy. Some people also report a sense of unusual smell; this may raise a possibility of a hippocampal abnormality or a tumor in that area.
Complex partial seizures can be associated with a fixed stare, impaired consciousness, fumbling with their fingers or lip-smacking movements that last 30 to 60 seconds. There can be a posture change in an arm that also can help to delineate the location of these seizures. Some people also note problems where they speak gibberish or lose their ability to speak in a sensible manner. Some individuals report difficulty with the language, particularly if the seizures are coming from the dominant temporal lobe. Some people may have a generalized tonic-clonic jerking and this can lead to weakness after the seizure has stopped.
Some individuals can also have prolonged seizures and in some rare situations, status epilepticus may occur.
