adminTemporal lobe seizures originate in the temporal lobes of your brain, which process emotions and are important for short-term memory.
Some symptoms of a temporal lobe seizure may be related to these functions, including having odd feelings such as euphoria, déjà vu (The eerie feeling that you have been here and done this before) or fear.
During a temporal lobe seizure, you may remain aware of what is happening. During more intense seizures, you may look awake but be unresponsive. Your lips and hands may make purposeless, repetitive movements.
Temporal lobe seizures may stem from an anatomical defect or scar in your temporal lobe, but the cause is often unknown. Temporal lobe seizures are treated with medication. For some people who do not respond to medication, surgery may be an option.
Symptoms
An unusual sensation (aura) may precede a temporal lobe seizure, acting as a warning. Not everyone who has temporal lobe seizures has auras, and not everyone who has auras remembers them.
The aura is actually a simple partial or focal seizure one that does not impair consciousness.
Examples of auras include:
A sudden sense of unprovoked fear
A deja vu experience — a feeling that what is happening has happened before
A sudden or strange odour or taste
A rising sensation in the abdomen
Sometimes temporal lobe seizures impair your ability to respond to others (partial complex or focal dyscognitive seizures). This type of temporal lobe seizure usually lasts 30 seconds to two minutes.
Characteristic signs and symptoms include:
Loss of awareness of surroundings
Staring
Lip smacking
Repeated swallowing or chewing
Unusual finger movements, such as picking motions
After a temporal lobe seizure, you may have:
A period of confusion and difficulty speaking
Inability to recall what occurred during the seizure
Unawareness of having had a seizure
Extreme sleepiness
In extreme cases, what starts as a temporal lobe seizure evolves into a generalised tonic-clonic (grand mal) seizure — featuring convulsions and loss of consciousness.
When to see a doctor
Seek medical advice in these circumstances.There is need for emergency medical care if:
A seizure lasts more than five minutes
The person does not recover completely or as quickly as usual after the seizure is over
Seizures keep repeating in a single day
Causes
Often, the cause of temporal lobe seizures remains unknown. However, they can be a result of a number of factors, including:
Traumatic brain injury
Infections, such as encephalitis or meningitis, or history of such infections
A process that causes scarring (gliosis) in a part of the temporal lobe called the hippocampus
Blood vessel malformations in the brain
Stroke
Brain tumours
Genetic syndromes
During normal waking and sleeping, your brain cells produce varying electrical activity. If the electrical activity in many brain cells becomes abnormally synchronised, a convulsion or seizure may occur.
If this happens in just one area of the brain, the result is a focal seizure. A temporal lobe seizure is a partial seizure that originates in one of the temporal lobes.
Complications
Over time, repeated temporal lobe seizures can cause the part of the brain that is responsible for learning and memory (hippocampus) to shrink. Brain cell loss in this area may cause memory problems.
Tests and diagnosis
Medical history
Your doctor will need a detailed description of the seizures, preferably from a witness, because most people who have temporal lobe seizures do not remember the episodes.
Neurological exam
If you or your child has had a seizure, your doctor likely will perform a neurological exam that tests:
Reflexes, Muscle tone, Muscle strength, Sensory function, Gait, Posture, Coordination, Balance
The doctor may also ask questions to assess your thinking, judgment and memory.
Blood tests and scans
Blood tests may be ordered to check for problems that could be causing or triggering the seizures. The doctor may also suggest scans or tests designed to detect abnormalities within the brain.
Electroencephalogram (EEG). An EEG displays the electrical activity of your brain as recorded by electrodes attached to your scalp.
People with epilepsy often have changes in their brain wave patterns, even when not having a seizure. The EEG sometimes can help indicate the type of seizures you are having.
In some cases, a doctor may recommend video-EEG monitoring in the hospital. This allows your doctor to compare second by second the behaviours observed during a seizure with your EEG pattern.
This can help your doctor pinpoint the type of seizure disorder you have, which helps to identify appropriate treatments, and can help ensure that the seizure diagnosis is correct.
Magnetic resonance imaging (MRI).
An MRI machine produces detailed images of your brain. Although many people with seizures and epilepsy have normal MRIs, certain MRI abnormalities may provide a clue to the cause of the seizures.
During the test, you will lie on a padded table that slides into the MRI machine. Your head will be immobilised in a brace, to improve precision. The test is painless, but some people experience claustrophobia inside the MRI machine’s close quarters. If you think you may have this reaction, tell your doctor before the study.
Single-photon emission computerised tomography (SPECT). Sometimes used when the area of seizure onset is unclear, SPECT imaging requires two scans — one during a seizure and one during a non-seizure period, each performed on separate days. Radioactive material is injected for both scans.
The scans are then compared to find the area of the brain with the greatest activity during the seizure. The resulting image is then superimposed onto the MRI. This is used with EEG information to help guide the surgeons.
Treatment and drugs
Medications
Numerous medications are available to treat temporal lobe seizures. However, many people do not achieve seizure control with medications alone, and side effects, including fatigue, weight gain and dizziness, are common.
Surgery
If you have temporal lobe seizures that do not respond to medication, you may be evaluated for surgery. For some people, surgery eliminates or greatly reduces the number of seizures.
Surgery is generally not an option if:
Your seizures come from a region of the brain that performs vital brain functions
Your seizures come from more than one area
Your seizure focus cannot be identified
Preparing for surgery
Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you are considering. You may also want to request a second opinion before having surgery.
Before surgery, you will need:
a comprehensive evaluation
MRI scans of your brain
observation of your seizures in a hospital-based monitoring unit using video recordings and EEG
After surgery
Most people need to continue taking medication to help ensure that seizures do not recur. However, if surgery appears successful, medications can sometimes be reduced and occasionally discontinued.
Vagus nerve stimulation
A device called a vagus nerve stimulator may be an option if medications are ineffective or cause serious side effects. The stimulator is implanted into your chest under the collarbone. Wires from the stimulator are attached to the vagus nerve in your neck.
The device turns on and off according to an adjustable programme and can be activated with a magnet. The device does not detect seizures. It is usually well-tolerated, but it is not a replacement for medication.
Responsive neuro-stimulation
This is a device for treating seizures that do not respond to medication. The device detects seizure activity and delivers an electrical stimulation to the detected area. The device is implanted on the surface of the brain or within the brain tissue, and attached to a battery-powered generator, which is implanted in the skull, close to the brain.
Deep brain stimulation
Deep brain stimulation involves implanting electrodes into a part of the brain called the thalamus. In highly selected cases, it may be beneficial in treating seizures that do not respond to medication. More study is needed.
Pregnancy and seizures
The most important thing to remember is to plan pregnancy. Women who are on medications for seizures usually are able to have healthy pregnancies. However, certain medications, such as valproic acid , taken during pregnancy are known to increase the risk of birth defects.
Seizures pose a risk to a developing baby, so it is generally not recommended to stop medications during pregnancy.
Discuss these risks with your doctor. Because pregnancy can alter medication levels, preconception planning is particularly important for women with seizures.
If you take medication for seizures and may become pregnant, taking prescription folic acid daily before you become pregnant can help prevent birth defects related to seizure medication.
The risk of birth defects is considered to be higher in women taking more than one drug. If your seizures cannot be well-controlled with other medication, discuss the potential risks with your doctor.
Contraception and anti-seizure medications
Some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if you should consider other forms of contraception.
Lifestyle and home remedies
Certain activities can be dangerous if you have a seizure while doing them. Activities include:
Swimming- If you go in water, do not go alone and be sure to wear a life preserver.
Bathing- Bathing also can pose a risk of drowning. Shower instead.
Working high up- You could fall during a seizure.
Driving a car or operating other equipment. All states have licensing restrictions for driving for people with a history of seizures. The rules differ from state to state.
Consider wearing a medical alert bracelet to help emergency medical personnel. The bracelet should state whom to contact in an emergency, what medications you use and your medication allergies.
Coping and support
Even after they are under control, seizures can affect your life. Temporal lobe seizures may present even more of a coping challenge because people may not recognise the unusual behaviour as a seizure. Children may get teased or be embarrassed by their condition, and living with the constant threat of another seizure may frustrate children and adults
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