Temporal Lobe Epilepsy

Temporal lobe epilepsy is a common type of epilepsy where seizures begin in the temporal lobes of your brain. These seizures can cause changes in your emotions, memory, and senses. It is often treatable with medication, but some people may need other therapies, including surgery, to control their seizures.

What is Temporal Lobe Epilepsy?

Temporal lobe epilepsy is a condition where you experience recurring seizures that start in one or both of your temporal lobes. These lobes are important for memory, emotions, and processing sensory information. It is the most common type of focal epilepsy, meaning seizures begin in a specific area of the brain.

Your brain has two temporal lobes, one on each side of your head, located behind your temples. These areas play a key role in how you process sounds, understand language, form memories, and manage emotions. When someone has temporal lobe epilepsy, abnormal electrical activity in these areas causes seizures. Seizures are sudden, uncontrolled bursts of electrical activity in the brain. In temporal lobe epilepsy, these bursts disrupt the normal function of the temporal lobes, leading to a variety of symptoms. The seizures can be either focal aware (you remain conscious) or focal impaired awareness (your consciousness is affected), and sometimes they can spread to other parts of the brain, causing a generalized seizure.

Symptoms

Symptoms of temporal lobe epilepsy vary depending on whether you are fully aware during the seizure or if your awareness is impaired. Common signs include unusual sensations, strong emotions like fear, memory changes, and repetitive automatic behaviors such as lip smacking or fumbling.

Many people with temporal lobe epilepsy experience a warning sign, called an aura, before a seizure. An aura is a type of focal aware seizure where you remain conscious. These can include a sudden feeling of déjà vu (feeling like you've experienced something before) or jamais vu (feeling like something familiar is strange), sudden intense fear or joy, a rising sensation in your stomach, or unusual smells or tastes. When awareness is impaired, you may appear to be awake but are unresponsive to your surroundings. During these focal impaired awareness seizures, you might stare blankly, make repetitive movements like chewing, lip smacking, fumbling with clothes, or walking in circles. After the seizure, you may feel confused, tired, and have no memory of what happened during the seizure. These seizures usually last between 30 seconds and 2 minutes.

Causes & risk factors

The exact cause of temporal lobe epilepsy is often unknown, but it can be linked to various factors that damage the brain. Common causes include head injuries, infections, and structural changes in the brain, such as scarring in the hippocampus, a part of the temporal lobe.

One of the most common identifiable causes is hippocampal sclerosis, which is scarring of the hippocampus. This small area deep within the temporal lobe is vital for memory and learning. Other potential causes include severe head trauma, brain infections like meningitis or encephalitis, strokes, or brain tumors. Certain risk factors can increase your likelihood of developing temporal lobe epilepsy. These include a history of prolonged or severe febrile seizures (seizures caused by high fever) in childhood, a family history of epilepsy, or complications during birth that led to brain injury. In many cases, however, no clear cause can be identified, and the condition is considered idiopathic.

How it's diagnosed

Diagnosing temporal lobe epilepsy involves a review of your symptoms and medical history, along with several tests to examine your brain's electrical activity and structure. Key diagnostic tools include an electroencephalogram (EEG) to record brain waves and magnetic resonance imaging (MRI) to visualize brain structures.

Your doctor will start by asking detailed questions about your seizures, including what you experience before, during, and after them. They may also ask family members or witnesses to describe what they observed. A neurological examination will assess your motor skills, sensory function, and mental status. An electroencephalogram (EEG) is a primary test that measures electrical activity in your brain. During an EEG, small electrodes are placed on your scalp to detect abnormal brain wave patterns that are characteristic of seizures. A magnetic resonance imaging (MRI) scan of your brain provides detailed images of brain structures, which can help identify abnormalities like hippocampal sclerosis, tumors, or other lesions that might be causing the seizures. Sometimes, other imaging tests like PET scans or SPECT scans are used to pinpoint the exact area where seizures originate.

Treatment options

Treatment for temporal lobe epilepsy typically begins with anti-seizure medications (ASMs) to help control seizures. If medications are not effective, other options may include surgery to remove the affected brain tissue or device therapies that stimulate specific brain areas to reduce seizure frequency.

Anti-seizure medications are the first line of treatment for most people. These medications work by stabilizing electrical activity in the brain to prevent seizures. Your doctor will carefully choose the right medication and dosage for you, often starting with a single drug and adjusting as needed. It's important to take these medications consistently as prescribed. For people whose seizures are not controlled by medication (known as drug-resistant epilepsy), surgery may be an option. The most common surgical procedure is a temporal lobectomy, where the part of the temporal lobe causing seizures is removed. This surgery can be highly effective for carefully selected patients. Other treatments include vagus nerve stimulation (VNS), responsive neurostimulation (RNS), or deep brain stimulation (DBS), which involve implanting devices that send electrical pulses to the brain or nerves to help control seizures. A special diet, such as the ketogenic diet, may also be considered for some individuals.

Recovery & outlook

The outlook for temporal lobe epilepsy varies, but many people can achieve good seizure control with treatment. While some individuals may become seizure-free, others might continue to experience seizures, requiring ongoing management. Recovery often involves adapting to the condition and managing potential side effects or cognitive changes.

About 2 out of 3 people (60-70%) with temporal lobe epilepsy respond well to anti-seizure medications and can achieve good seizure control or even become seizure-free. For those who do not respond to medication, surgery can offer a significant chance of seizure freedom, with success rates varying depending on the specific procedure and individual factors. Living with temporal lobe epilepsy can impact daily life, including memory, mood, and social interactions. Some people may experience memory difficulties, particularly with new information, or changes in emotional regulation. Ongoing support, including therapy and lifestyle adjustments, can help manage these challenges. Regular follow-ups with your healthcare team are crucial to monitor your condition and adjust treatment as needed to optimize your quality of life.

When to see a doctor

You should see a doctor if you experience what you believe is your first seizure, or if you notice any new or worsening symptoms related to your epilepsy. Seek immediate medical attention if a seizure lasts longer than five minutes, if you have repeated seizures without full recovery in between, or if you sustain an injury during a seizure.

It is important to seek medical advice promptly if you experience any seizure-like activity for the first time. If you have already been diagnosed with temporal lobe epilepsy, contact your doctor if your seizure patterns change, if your medications cause bothersome side effects, or if you have concerns about your condition. Call emergency services (such as 911) or go to the nearest emergency room if a seizure lasts longer than five minutes, if you have multiple seizures in a row without regaining consciousness, if you have difficulty breathing after a seizure, or if you injure yourself significantly during a seizure. These situations could indicate a medical emergency requiring urgent care.

Frequently asked questions

Can temporal lobe epilepsy be cured?

Temporal lobe epilepsy is not always curable, but it is often manageable. Many people achieve seizure freedom with medication or surgery. For those who don't, treatments aim to reduce seizure frequency and severity, significantly improving quality of life.

Is temporal lobe epilepsy hereditary?

While some cases of temporal lobe epilepsy have a genetic link, it is not always hereditary. A family history of epilepsy can increase your risk, but many people develop the condition without any known genetic predisposition.

What is an 'aura' in temporal lobe epilepsy?

An aura is a type of focal aware seizure that acts as a warning sign before a larger seizure. It involves unusual sensations like déjà vu, strange smells or tastes, or sudden intense emotions, and you remain fully conscious during it.

Can stress trigger temporal lobe seizures?

Yes, stress can be a seizure trigger for some individuals with temporal lobe epilepsy. Other common triggers include lack of sleep, illness, alcohol, caffeine, or certain medications. Identifying and managing your personal triggers can help reduce seizure frequency.

How does temporal lobe epilepsy affect memory?

Temporal lobe epilepsy can affect memory because the temporal lobes are crucial for memory formation and retrieval. Some people experience difficulties with short-term memory, learning new information, or recalling specific events, especially after seizures or if the condition is long-standing.

What lifestyle changes can help manage temporal lobe epilepsy?

Managing temporal lobe epilepsy often involves maintaining a consistent sleep schedule, avoiding known seizure triggers, managing stress, and adhering strictly to prescribed medications. Regular exercise and a balanced diet can also contribute to overall well-being and seizure control.

Sources

• MedlinePlus — Temporal Lobe Epilepsy
• Mayo Clinic — Temporal Lobe Epilepsy
• Cochrane Library — Temporal Lobe Epilepsy