What is Temporal Lobe Epilepsy?
Epilepsy is the most common neurological condition which is characterized by recurrent seizures. It leads to abnormal brain activity causing periods of unusual behavior, sensations and loss of awareness.
Temporal lobe epilepsy is the most common type of epilepsy, in which the seizures originate in the temporal lobe of the brain. The temporal lobe is responsible for the emotion process and the short-term memory. The epilepsy of the temporal lobe is of two types:
- In the middle inner region of the temporal lobe
- In the neocortical or the side of the temporal lobe
According to the type of seizure, temporal lobe epilepsy is further classified as,
- Complex partial seizures: This type is characterized by loss of consciousness.
- Simple partial seizure: In this type, the patient stays conscious.
Causes of Temporal Lobe Epilepsy
The cause of temporal lobe epilepsy remains unknown, but there are various factors which can lead to this condition such as:
- Traumatic brain injury
- Blood vessel malformation in the brain
- Genetic Syndromes
- Brain tumors
- Infection such as encephalitis and meningitis
- Any process which leads to scarring in the hippocampus (a part of the temporal lobe of the brain)
- An abnormal electrical activity of the brain
Signs and Symptoms of Temporal Lobe Epilepsy
When a seizure is originating in the temporal lobe, there might be few warning signs or symptoms such as:
- Abnormal sensation such as unusual feeling under the breastbone or in the stomach can be a sign of temporal lobe epilepsy.
- Hallucinations and sudden strange odor or taste.
- A déjà vu feeling or a sense of familiarity with the events or happenings is a sign of temporal lobe epilepsy.
- A sudden change in emotions, or intense emotions to anything happening at that time.
These early feeling does not necessarily occur in all the patient suffering from temporal lobe epilepsy. Most of the time people do not remember experiencing any aura. These signs of temporal lobe epilepsy last for a few minutes before the seizure.
As the temporal lobe epilepsy begins the person may experience motor disturbances, sensory symptoms or autonomic symptoms.
Motor Disturbances Include:
- One-sided rhythmic muscle contraction of body or face
- Abnormal behavior of mouth such as smacking lips repeated chewing or swallowing
- Forced or abnormal head movement such as forced turning of head and eye
- Unusual finger movements such as repetitive picking on clothes
The Sensory Symptoms Of Temporal Lobe Epilepsy Include:
- Tingling on skin
- A sensation of something crawling on the skin
The sensation might start at one place and then spread.
The Autonomic Symptoms Of Temporal Lobe Epilepsy Are:
- Abdominal pain
- Dilated pupil
- Rapid heartbeat
Depending on whether the patient was conscious during the temporal lobe epilepsy, they may or may not be able to recall what actually happened during the seizure. After the temporal lobe epilepsy, the patient experiences a period of confusion, extreme sleepiness, and difficulty in speaking, which may last for several minutes.
Only the extreme case of temporal lobe seizure evolves into a generalized tonic-clonic or a grand mal seizure.
If someone has the seizure for the first time, or if the seizure lasts for more than two minutes, or if multiple seizures occur one after another, never delay getting an emergency help.
How is Temporal Lobe Epilepsy Diagnosed?
The doctor begins with a medical history of the patient which helps him to know about any history of birth trauma, head injury, medicinal intake, alcohol intake, or the history of infections such as meningitis or encephalitis.
The doctor may advise the following tests to diagnose temporal lobe epilepsy:
Neurological Examination: The problem with the brain or the nervous system can be determined by performing a behavior test, mental function test, and the motor ability test.
Blood Test: A blood test is performed to check for infection, a genetic condition, blood sugar levels and electrolyte imbalance.
MRI: MRI of the brain is performed to look for any brain abnormality or lesions associated with the temporal lobe.
EEG: The electrical activity of the brain is measured by performing an EEG. This test helps the doctors to determine whether the seizure would reoccur and also help rule out any other condition which mimics epilepsy.
CT: This test gives cross-sectional images of the brain. This helps in revealing any brain abnormality which can be a cause of seizure such as tumors, cysts, and bleeding.
PET: Pet is done by injecting a small dose of radioactive material into the veins. This helps visualize the areas of the brain and detect any abnormality.
Single-photon emission computerized tomography (SPECT): This test gives a detailed 3D map of the blood activity in the brain. It is done by injecting low-dose of radioactive material in the veins.
Treatment of Temporal Lobe Epilepsy
People suffering from temporal lobe epilepsy are given anti-convulsion medications. These drugs bear a lot of side effects such as tiredness, weight gain, and dizziness.
Those who do not respond well to these medications require other medical interventions for the treatment of temporal lobe epilepsy. It helps in reducing the episodes of seizure a person experiences.
Temporal lobectomy is a surgical procedure which involves the removal of the abnormal part of the brain. However, an unsuccessful surgery also poses risk as it may lead to other neurological problems.
Other medical intervention procedures for the treatment of temporal lobe epilepsy are:
Vagus Nerve Stimulation: In this procedure, a device is implanted under the collarbone. It stimulates the left vagus nerve which helps inhibit seizures.
Responsive Neurostimulation: In responsive stimulation, the stimulating device is implanted on the surface of the brain. A battery-powered generator is attached to the skull near the brain. The device helps in stopping the seizure by sending an electrical impulse to the affected area. It helps in treating multifocal epilepsy.
Deep Brain Stimulation: In this procedure, the electrodes are implanted in the hypothalamus. These electrodes emit electrical signals which stop the seizures.
What is the Prognosis/Outlook of Temporal Lobe Epilepsy?
In many people, the epilepsy is successfully treated with medications or surgery. There is a higher risk of memory and mood difficulties in the people with drug-resistant medial temporal lobe epilepsy. This further leads to impairment in quality of life and increases the risk of death.
If the disease is properly managed through medications and lifestyle changes, people can actually live a seizure-free life.
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