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Temporal lobe epilepsy
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Temporal lobe epilepsy
In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the mesial (medial) temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery, and dietary treatments may improve seizure control.
Under the International League Against Epilepsy (ILAE) 2017 classification of the epilepsies, focal onset epilepsy occurs from seizures arising from a biological neural network within a single cerebral hemisphere. Temporal lobe epilepsy occurs from seizures arising within the lobe. It is the most common focal onset epilepsy, and 80% of temporal lobe epilepsy is mesial (medial) temporal lobe epilepsy, temporal lobe epilepsy arising from the inner (medial) part of the temporal lobe that may involve the hippocampus, parahippocampal gyrus, or amygdala. The less common lateral temporal lobe or neocortical temporal lobe seizures arise from the outer (lateral) temporal lobe. These types of TLE are very rare due to the genetic cause or lesions such as tumor, birth defect, or blood vessel abnormalities in the temporal lobe.
The ILAE 2017 classification distinguishes focal aware from focal impaired seizures. A focal aware temporal lobe seizure occurs if a person remains aware of what occurs during the entire seizure; awareness may be retained even if impaired responsiveness occurs during the seizure. A focal impaired awareness temporal lobe seizure occurs if a person becomes unaware during any part of the seizure.
Approximately 80% of seizures in the temporal lobe begin in the mesial temporal region, frequently starting in or around the hippocampus. The hippocampus, found in both temporal lobes, is essential for memory and learning.
During a temporal lobe seizure, a person may experience a seizure aura; an aura is an autonomic, cognitive, emotional, or sensory experience that commonly occurs during the beginning part of a seizure. The common mesial temporal lobe seizure auras include a rising epigastric feeling, abdominal discomfort, taste (gustatory), smell (olfactory), tingling (somatosensory), fear, déjà vu, jamais vu, flushing, or rapid heart rate (tachycardia). A person may then stare blankly, appear motionless (behavioral arrest) and lose awareness. Repeated stereotyped motor behaviors (automatisms) may occur; these include repeated swallowing, lip smacking, picking, fumbling, patting, or vocalizations. Dystonic posture is an unnatural stiffening of one arm occurring during a seizure. A dystonic posture on one side of the body commonly indicates seizure onset from the opposite side of the brain e.g. right arm dystonic posture arising from a left temporal lobe seizure. Impaired language function (dysphasia) during, or soon following, a seizure is more likely to occur when seizures arise from the language dominant side of the brain.
The common auras from seizures arising from the primary auditory cortex include vertigo, humming sounds, ringing sounds, buzzing sounds, songs or voices, or altered sensations. Lateral temporal lobe seizures arising from the temporal-parietal lobe junction may cause complex visual hallucinations. In comparison to mesial temporal lobe seizures, lateral temporal lobe seizures are briefer in duration, occur with earlier loss of awareness, and are more likely to become focal than bilateral tonic-clonic seizures. Impaired language function (dysphasia) during or soon following a seizure is more likely to occur when seizures arise from the language dominant side of the brain.
The major cognitive impairment in mesial temporal lobe epilepsy is a progressive memory impairment. This involves declarative memory impairment, including episodic memory and semantic memory, and is worse when medications fail to control seizures. Mesial temporal lobe epilepsy arising from the language dominant hemisphere impairs verbal memory, and mesial temporal lobe epilepsy arising from the language non-dominant hemisphere impairs nonverbal memory.
Psychiatric disorders are more common among those with epilepsy, and the highest prevalence occurs among those with temporal lobe epilepsy. The most common psychiatric comorbidity is major depressive disorder. Other disorders include post-traumatic stress disorder, generalized anxiety disorder, psychosis, obsessive–compulsive disorder, schizophrenia, bipolar disorder, substance use disorder, and a ~9% prevalence of suicide.
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Temporal lobe epilepsy
In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the mesial (medial) temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery, and dietary treatments may improve seizure control.
Under the International League Against Epilepsy (ILAE) 2017 classification of the epilepsies, focal onset epilepsy occurs from seizures arising from a biological neural network within a single cerebral hemisphere. Temporal lobe epilepsy occurs from seizures arising within the lobe. It is the most common focal onset epilepsy, and 80% of temporal lobe epilepsy is mesial (medial) temporal lobe epilepsy, temporal lobe epilepsy arising from the inner (medial) part of the temporal lobe that may involve the hippocampus, parahippocampal gyrus, or amygdala. The less common lateral temporal lobe or neocortical temporal lobe seizures arise from the outer (lateral) temporal lobe. These types of TLE are very rare due to the genetic cause or lesions such as tumor, birth defect, or blood vessel abnormalities in the temporal lobe.
The ILAE 2017 classification distinguishes focal aware from focal impaired seizures. A focal aware temporal lobe seizure occurs if a person remains aware of what occurs during the entire seizure; awareness may be retained even if impaired responsiveness occurs during the seizure. A focal impaired awareness temporal lobe seizure occurs if a person becomes unaware during any part of the seizure.
Approximately 80% of seizures in the temporal lobe begin in the mesial temporal region, frequently starting in or around the hippocampus. The hippocampus, found in both temporal lobes, is essential for memory and learning.
During a temporal lobe seizure, a person may experience a seizure aura; an aura is an autonomic, cognitive, emotional, or sensory experience that commonly occurs during the beginning part of a seizure. The common mesial temporal lobe seizure auras include a rising epigastric feeling, abdominal discomfort, taste (gustatory), smell (olfactory), tingling (somatosensory), fear, déjà vu, jamais vu, flushing, or rapid heart rate (tachycardia). A person may then stare blankly, appear motionless (behavioral arrest) and lose awareness. Repeated stereotyped motor behaviors (automatisms) may occur; these include repeated swallowing, lip smacking, picking, fumbling, patting, or vocalizations. Dystonic posture is an unnatural stiffening of one arm occurring during a seizure. A dystonic posture on one side of the body commonly indicates seizure onset from the opposite side of the brain e.g. right arm dystonic posture arising from a left temporal lobe seizure. Impaired language function (dysphasia) during, or soon following, a seizure is more likely to occur when seizures arise from the language dominant side of the brain.
The common auras from seizures arising from the primary auditory cortex include vertigo, humming sounds, ringing sounds, buzzing sounds, songs or voices, or altered sensations. Lateral temporal lobe seizures arising from the temporal-parietal lobe junction may cause complex visual hallucinations. In comparison to mesial temporal lobe seizures, lateral temporal lobe seizures are briefer in duration, occur with earlier loss of awareness, and are more likely to become focal than bilateral tonic-clonic seizures. Impaired language function (dysphasia) during or soon following a seizure is more likely to occur when seizures arise from the language dominant side of the brain.
The major cognitive impairment in mesial temporal lobe epilepsy is a progressive memory impairment. This involves declarative memory impairment, including episodic memory and semantic memory, and is worse when medications fail to control seizures. Mesial temporal lobe epilepsy arising from the language dominant hemisphere impairs verbal memory, and mesial temporal lobe epilepsy arising from the language non-dominant hemisphere impairs nonverbal memory.
Psychiatric disorders are more common among those with epilepsy, and the highest prevalence occurs among those with temporal lobe epilepsy. The most common psychiatric comorbidity is major depressive disorder. Other disorders include post-traumatic stress disorder, generalized anxiety disorder, psychosis, obsessive–compulsive disorder, schizophrenia, bipolar disorder, substance use disorder, and a ~9% prevalence of suicide.
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