Temporal Lobe Epilepsy

November 12, 2012

Temporal Lobe Epilepsy

Temporal lobe epilepsy (TLE) is characterized by partial seizures that involve both the temporal lobes. This condition may be categorized as simple or complex, and affects almost 50 percent of epilepsy patients.

Causes

Bacterial and viral infections such as herpes encephalitis and meningitis may lead to complications such as temporal lobe epilepsy. TLE may also occur as a result of head injuries that cause hemorrhages and blood clots in the brain. Malformation of blood vessels, tumors of brain and spinal cord such as hamartomas and gliomas, and idiopathies can cause TLE. Hippocampal sclerosis also causes temporal lobe epilepsy, which begins in late childhood, then remits, but reappears in adolescence or early adulthood. Children exposed to febrile seizures can are also at an increased risk of TLE.

Symptoms

Most patients with temporal lobe epilepsy experience aura for short periods of time. This can cause sensory and psychic symptoms in the patients such as olfactory, auditory and gustatory illusions, confusion and hallucinations. Seizures are also characterized by dilated motion and motionless stare. Many patients report distortions of shape and size, and are unable to identify distant objects. It can also cause fear, anxiety, increased heart rate and sweating. Other symptoms include digestive problems such as nausea and fullness.

Diagnosis

Your doctor may perform extensive physical and mental evaluation before confirming the diagnosis of temporal lobe epilepsy. Most doctors look for characteristic signs of the disease, which include:

  • Abrupt seizures with no aura and confusion that last for less than 30 seconds, or complex partial seizures that are preceded by a distinct aura, lasts longer than a minute with significant periods of confusion.

  • Sleep apnea and drowsiness during daytime.

  • Periodic limb movement disorder.

  • Tardive dyskinesia.

  • Panic attacks.

Your doctor may also use interracial EEG, MRI scan, positron emission tomography, single-photon emission computed tomography and video-EEG for complete diagnosis of TLE.

Treatment

Anticonvulsant medications such as carbamazepine, levetiracetam and oxcarbazepine may be prescribed by your doctor to treat TLE. Other anti-epilepsy medications include eslicarbazepine acetate, lacosamide and phenytoin. You doctor may also propose vagus nerve stimulation with a high-frequency stimulation rate results with a battery-operated stimulator device that is implanted in the left vagus nerve in the neck.

Prognosis

Patients with refractory temporal lobe epilepsy (TLE) are at a higher risk of sudden death that general population. About 50% of patients can become seizure-free with medical treatment.

Surgery can improve success rate by 70-80%. Some patients may have impaired memory or language function.

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