What is temporal lobe epilepsy?
Epilepsy is a brain disorder that causes changes in brain cell activity that result in seizures, periods of unusual behavior or feelings, and in some cases a loss of consciousness. Temporal lobe epilepsy is one of 20 different kinds of epilepsy.
There are two types of temporal lobe epilepsy. Each is defined by the part of the temporal lobe in which it originates. One starts in the medial (inner) region of the temporal lobe, while the other starts in the neocortical (side) region of the temporal lobe. The brain’s temporal lobes handle emotions and also help with the processing and storage of short-term memories.
Temporal lobe epileptic seizures are further classified. If there is a loss of consciousness, they’re called complex partial seizures. If you stay conscious, they’re called simple partial seizures. In most cases, people remain conscious during temporal lobe seizures, making them simple partial seizures.
Of all types of epilepsy, temporal lobe epilepsy is most common. It affects about 60 percent of all people with epilepsy and can occur at any age. There are many potential causes, and often the exact cause is unknown.
Experts say some possible causes of temporal lobe seizures include:
- severe traumatic brain injury
- infections or a history of infections like meningitis or encephalitis
- scarring (gliosis) in the hippocampus part of the temporal lobe
- blood vessel deformities in the brain
- brain tumors
- abnormal electrical activity in the brain
When a temporal lobe seizure starts to occur, a person may experience sudden, unusual feelings, such as:
- deja vu
- extreme happiness
- a rising sensation in the abdomen
These early signs are called auras or warnings, and they may last for a few seconds up to a few minutes before the seizure occurs. Other possible auras include hallucinations of sounds, voices, people, smells, and tastes. Not all people who experience temporal lobe seizures experience auras. Sometimes people do not remember experiencing an aura.
Once the seizure begins, you may remain conscious but your body will begin to twitch and display unconscious actions. You’ll make repetitive, uncontrollable movements such as lip smacking, swallowing, chewing, staring, or hand rubbing. Temporal lobe seizures look different in different people. They may be long or short, and they may be intense or mild to the point where you don’t notice it’s happening.
After a temporal lobe seizure occurs, you may experience:
- trouble speaking
- being unaware a seizure occurred
- intense fatigue
Rarely, people who experience a temporal lobe seizure will go on to experience a generalized tonic-clonic (grand mal) seizure, which causes convulsions and a loss of consciousness.
The most common risk factor for temporal lobe epilepsy is having had a seizure, especially an unusually long-lasting seizure, with a fever at some point in life. Other common risk factors for temporal lobe epilepsy include:
- head trauma with loss of consciousness
- early childhood injuries
- birth injuries
- brain defects
- brain tumors
Most cases of temporal lobe epilepsy begin in a person’s late teens or late 20s. Experts say that for women, hormonal changes affecting their menstrual cycles and ovulation may result in a higher number of seizures.
A doctor can diagnose temporal lobe seizures from a detailed description of how the seizures occurred. It’s often suggested that a third-party witness describe the seizures, as they may be better able to recall what happened.
The standard radiological procedure used to diagnose temporal lobe epilepsy is magnetic resonance imaging (MRI), which is performed on the brain. Doctors look for characteristic brain abnormalities associated with temporal lobe epilepsy.
Doctors will also perform an electroencephalogram (EEG), a test used to measure the brain’s electrical activity. Sharp waves seen in an EEG in the correct location are typically indicative of temporal lobe epilepsy. Doctors sometimes record seizures in a video EEG monitor, usually when determining whether or not surgery would be helpful in treating localized seizures.
Most people with temporal lobe epilepsy respond well to anti-epilepsy drugs. However, these drugs come with various side effects, including tiredness, weight gain, and dizziness. They also may interfere with other medications, such as oral contraceptives.
At least one-third of people with temporal lobe epilepsy do not respond to medication alone and require other medical interventions to treat their disorder. Surgery is another common treatment for people with temporal lobe epilepsy. It’s used to eliminate or reduce the number of seizures a person experiences. All surgeries carry risks, however, and an unsuccessful surgery may actually create neurological problems.
Other types of medical interventions used to treat temporal lobe epilepsy include:
- Vagus nerve stimulation: A stimulating device is surgically implanted into the chest under the collarbone with wires from the stimulator connecting to the vagus nerve in the neck may help reduce the frequency and intensity of seizures.
- Responsive neurostimulation: A stimulating device is implanted on the surface of the brain or in the brain tissue, attached to a battery-powered generator that’s attached to the skull near the brain. The device detects seizures and sends an electrical stimulation to the area where the seizure is occurring in an attempt to stop it.
- Deep brain stimulation: This is an experimental treatment that involves implanting electrodes into a part of the brain called the thalamus. These electrodes emit electrical signals that stop seizures.
Lifestyle changes can also help reduce the risks of having, or being injured during, a seizure. Some activities can be dangerous if you have temporal lobe epilepsy or are otherwise prone to seizures. These include:
- Swimming: If you choose to swim, don’t go alone and always wear a life preserver.
- Bathing: Shower instead of sitting in a bathtub due to the risk of drowning in a tub.
- Working high off the ground: Working on a ladder, roof, or other elevated place can be dangerous, as you could fall and injure yourself.
- Driving a car or operating machinery: States have varying licensing restrictions for people with a history of seizures.
You might want to consider wearing a medical alert bracelet that emergency personnel or people near you can refer to in case you have a seizure. It should list your condition, whom to contact in an emergency, what medications you take, and your medication allergies.
While temporal lobe epilepsy can be successfully treated with medication or surgery, it always poses a danger to those living with it and possibly others, especially during the operation of heavy machinery or motor vehicles. Additionally, people with epilepsy who are resistant to drug treatment are more likely to experience memory and mood problems. These challenges can lead to a reduced quality of life and an increased risk of death. If properly managed through medications and lifestyle adaptations, people with seizures can live a full life.