Temporal lobe epilepsy

Temporal lobe epilepsy DEFAULT

Temporal Lobe Epilepsy

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.

Focal onset seizures (partial seizures) »

What causes temporal lobe epilepsy?

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:

What are the symptoms of temporal lobe epilepsy?

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
  • anxiety

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
  • confusion
  • 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.

Who is at risk for temporal lobe epilepsy?

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
  • infections
  • 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.

How is temporal lobe epilepsy diagnosed?

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.

How is temporal lobe epilepsy treated?

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.

Natural treatments for epilepsy: Do they work? »

Activities to do with caution

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.

Bracelets and devices for people with epilepsy »

What is the outlook for temporal lobe epilepsy?

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.

Long-term prognosis for epilepsy »

Sours: https://www.healthline.com/health/temporal-lobe-epilepsy

Temporal Lobe Epilepsy (TLE)

What is temporal lobe epilepsy (TLE)?

Temporal lobe epilepsy is the most common form of focal epilepsy. About 6 out of 10 people with focal epilepsy have temporal lobe epilepsy. Seizures in TLE start or involve in one or both temporal lobes in the brain.

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There are two types of TLE:

  • Mesial temporal lobe epilepsy (MTLE) involves the medial or internal structures of the temporal lobe. Seizures often begin in a structure of the brain called the hippocampus or surrounding area. MTLE accounts for almost 80% of all temporal lobe seizures.
  • Neocortical or lateral temporal lobe epilepsy involves the outer part of the temporal lobe.

Medial temporal lobe epilepsy usually begins around age 10 or 20, but it can start at any age. Usually a person has had a seizure with fever or an injury to the brain in their early years.

There are a lot of older names for seizures that occur in TLE, including "psychomotor seizures," "limbic seizures," "temporal lobe seizures," "complex partial," and "simple partial." The modern name for these seizures is "focal onset seizures." Focal seizures are then described by whether a person stays awake and aware or has impaired awareness during a seizure.

Mesial temporal lobe epilepsy is often associated with changes or abnormal findings on MRI (magnetic resonance imaging). One of the most common findings is scarring in the temporal lobe. This is called hippocampal sclerosis (sclerosis means hardening or scarring). It may look like the hippocampus on one side, or both, has shrunk or is smaller.

MRI of Mesial Temporal Sclerosis

Right Mesial Temporal Sclerosis (MTS)

MRI of Mesial Temporal Sclerosis with flair

Right Mesial Temporal Sclerosis (MTS) with Flair

Also, see arrow in figure at the top of the page.

When the MRI is abnormal, seizures often do not stop with medication. In this case, surgery to remove the area causing the seizures is the best option for many people.

  • This is especially true when hippocampal sclerosis is on the side of the brain that is not involved with language. This is called the non-dominant side of the brain, which for most people is the right side.
  • Neuropsychological testing is important for any person considering epilepsy surgery. Testing helps guide doctors, people with epilepsy, and families about possible cognitive risks (attention, memory, and learning) compared to benefits of seizure control.

What type of seizures are seen?

Seizures in TLE include focal aware seizures, such as auras, and focal impaired awareness seizures.

  • Auras are the same as focal aware seizures. They used to be called simple partial seizures. They are the first symptoms of a seizure.
  • The most common auras are feelings of déjà-vu or some stomach upset.
  • Feelings of fear, panic, anxiety, a rising sensation coming from the stomach to the chest or throat, or butterflies with nausea are other common auras.
  • Some people may sense an unusual smell. This symptom may raise the possibility of a lesion or tumor in the hippocampus of the temporal lobe.
  • Sometimes the auras can be very hard to describe.

Focal impaired awareness seizures used to be called complex partial.

  • During this type of seizure, a person may have a fixed stare, be unaware or confused about what is going on around them, have fumbling with their fingers, or lip-smacking movements. The seizures last 30 seconds to a couple of minutes.
  • There can be unusual posturing (movement or positioning) in an arm. This can help identify where seizures start in the brain.
  • Some people also speak gibberish or lose their ability to speak in a sensible manner. Language problems are more common if the seizures are coming from the dominant temporal lobe.
  • The focal seizure can go into generalized tonic-clonic jerking. The person may be weak after the seizure has stopped.
  • Some people can also have prolonged seizures. Rarely, repeated or long seizures called status epilepticus may develop.
  • Seizures in neocortical or lateral temporal lobe epilepsy often start with an auditory aura, such as buzzing or hearing a specific sound.

A Typical Story

I get the strangest feeling – most of it can't be put into words.

"The whole world suddenly seems more real at first. It's as though everything becomes crystal clear. Then I feel as if I'm here but not here, kind of like being in a dream. It's as if I've lived through this exact moment many times before. I hear what people say, but they don't make sense. I know not to talk during the episode, since I just say foolish things. Sometimes I think I'm talking but later people tell me that I didn't say anything. The whole thing lasts a minute or two."

What are some risk factors for temporal lobe epilepsy?

Common risk factors that lead to developing TLE include

  • Brain injury including head trauma with loss of consciousness, birth injury, infections such as encephalitis or meningitis that happen early in life
  • Changes in the structure of a temporal lobe, such as brain malformations or tumors
  • The most common risk factor is a prolonged or focal febrile seizure.
    • About 2 out of 3 people with TLE have had a history of febrile seizures.
    • Three out of 4 of these were either prolonged or had complex features.
    • It is important to know that the vast majority of people with febrile seizures do not develop temporal lobe epilepsy.

How is TLE diagnosed?

Medial temporal lobe epilepsy is a clinical diagnosis. This means that a number of factors are put together. There isn’t one test for TLE.

  • It’s important to listen to a person describe their seizures in as much detail as possible or by hearing observations of a witness.
  • An MRI of the brain should be done to look for changes in the temporal lobe.
  • An EEG (electroencephalogram) should be done and often shows spike or sharp waves in the tip or front of the temporal lobe. These can be seen when a person is awake or asleep.
  • When seizures arise in more mesial (middle) temporal lobe areas, the EEG may only show rhythmic slowing during seizures. These may be hard to diagnose unless a typical seizure is recorded on the EEG.

Download these forms to help record and describe seizures:

How is TLE treated?

Seizure Medications

Many people with temporal lobe epilepsy achieve full seizure control with anti-seizure drugs. But almost a third of people may not respond to drug therapy.

Uncontrolled seizures may cause a number of problems. For example, people often report problems with memory, socialization, and a fear of leaving their home. They may restrict their daily activities, which leads to a decrease in quality of life.

Surgery

If seizures fail to respond to medication, then epilepsy surgery may be an option. When an MRI shows hippocampal sclerosis in the medial temporal lobe and EEGs show seizures starting in that same area, seizures may be cured by surgery. In some cases, up to 7 out of 10 people can be seizure-free after surgery with few problems afterwards.

Devices

If surgery is not possible or doesn't work, devices such as vagus nerve stimulation (VNS) or responsive neurostimulation (RNS) may help.

Finding the Right Treatment

What is the outlook?

Two out of 3 people with temporal lobe epilepsy achieve good seizure control with seizure medication. Seizures may also go away in some children with TLE. A good outcome is most often seen in people with normal MRI scans.

If the MRI is abnormal, there is a much higher risk that seizures will not respond to medicines (called drug-resistant epilepsy or DRE). Overall, the prognosis for people with drug-resistant medial temporal lobe epilepsy includes a higher risk for memory and mood problems, lower quality of life, and an increased risk for sudden unexpected death in epilepsy (SUDEP). If surgery can be done to control seizures, these risks and problems can be improved.

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Focal Epilepsy

Idiopathic Localization-Related Epilepsies (ILRE)

The cause of these localized (focal) seizures is not yet known, but some research points to a genetic component. The person’s brain and brain function may appear normal.

Treatment for these epilepsies starts with anticonvulsant medications. Epilepsy surgery such as laser ablation or temporal lobectomy may be an option, especially when the cause of the seizures is an abnormality in the brain such as mesial temporal sclerosis.

Frontal Lobe Epilepsy

Frontal lobe epilepsy is the term for recurring seizures beginning in the frontal lobe — the area of the brain behind the forehead. Because the frontal lobe is responsible for planning and executing movement and personality, frontal lobe epilepsy can have a dramatic effect on a patient’s quality of life.

Frontal lobe seizures are often very brief (less than 30 seconds) and tend to occur at night. They are typically simple or complex partial seizures and can quickly spread throughout the brain. Because there are so many connections between the frontal and temporal lobes, it can be difficult to determine which section of the brain is being affected.

Anticonvulsant medications are the most common first choice for treatment; if these do not control the seizures, surgery may be an option.

Temporal Lobe Epilepsy

Temporal lobe epilepsy is the term for recurring seizures beginning in the temporal lobe – the section of the brain located on the sides of the head behind the temples and cheekbones.

The temporal lobes are the areas of the brain that most commonly give rise to seizures. The mesial portion (middle) of both temporal lobes is very important in epilepsy — it is frequently the source of seizures and can be prone to damage or scarring.

Because there are so many diverse functions either in or closely related to the temporal lobes, these seizures may have a dramatic effect on the patient’s quality of life.

Seizures beginning in the temporal lobes may remain there, or they may spread to other areas of the brain. Depending on if and where the seizure spreads, the patient may experience the sensation of:

  • A peculiar smell (such as burning rubber)

  • Strong emotions (such as fear)

  • Abdominal/chest discomfort

  • Automatic, unconsciously repeated movements

  • Staring

  • Loss of awareness

Parietal Lobe Epilepsy

The parietal lobe is the section of the brain on the top and sides of the head. Known as the “association cortex,” the parietal lobe is responsible for connecting meaning to the brain’s functions. It is here that the brain creates a visual image, that sounds are recognized as words, and that the sense of touch is associated with a particular object. In some ways, the parietal lobe is where perception meshes with physical reality.

Parietal lobe epilepsy is very uncommon. Seizures starting in this area can cause sensory disturbances, such as heat, numbness or electrical sensations, weakness, dizziness, hallucinations, distortions of space and other symptoms.

Occipital Lobe Epilepsy

Occipital lobe epilepsy is the term for recurring seizures beginning in the occipital lobe, the section of the brain in the back of the head that is primarily responsible for vision. Seizures beginning in the occipital lobe are rare.

These seizures can cause a person to experience flashing bright lights or other visual changes on the left side of his or her visual field (if occurring in the right cortex), or on the right side (if occurring in the left cortex).

Sours: https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/focal-epilepsy

Temporal lobe epilepsy

Chronic focal seizure disorder

Medical condition

Temporal lobe epilepsy (TLE) is a chronic disorder of the nervous system characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. TLE is the most common form of epilepsy with focal seizures.[1] A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure.

TLE is diagnosed by taking a medical history, blood tests, and brain imaging. It can have a number of causes such as head injury, stroke, brain infections, structural lesions in the brain, or brain tumors, or it can be of unknown onset. The first line of treatment is through anticonvulsants. Surgery may be an option, especially when there is an observable abnormality in the brain. Another treatment option is electrical stimulation of the brain through an implanted device called the vagus nerve stimulator (VNS).[1]

Types[edit]

Over forty types of epilepsy are recognized and these are divided into two main groups: focal seizures and generalized seizures.[2]Focal seizures account for approximately sixty percent of all adult cases.[3] Temporal lobe epilepsy (TLE) is the single most common form of focal seizure.[4]

The International League Against Epilepsy (ILAE) recognizes two main types of temporal lobe epilepsy: mesial temporal lobe epilepsy (MTLE), arising in the hippocampus, the parahippocampal gyrus and the amygdala which are located in the inner (medial) aspect of the temporal lobe and lateral temporal lobe epilepsy (LTLE), the rarer type, arising in the neocortex at the outer (lateral) surface of the temporal lobe.[3] The seizures of LTLE are characterized by auditory or visual features. Autosomal dominant lateral temporal lobe epilepsy (ADLTLE) is a rare hereditary condition, often associated with mutations in the LGI1 gene.[5]

Signs and symptoms[edit]

When a seizure begins in the temporal lobe, its effects depend on the precise location of its point of origin, its locus. In 1981, the ILAE recognized three types of seizures occurring in temporal lobe epilepsy. The classification was based on EEG findings.[6] However, as of 2017 the general classification of seizures has been revised.[7] The newer classification uses three key features: where the seizures begin, the level of awareness during a seizure, and other features.[7]

Focal seizures[edit]

Focal seizures in the temporal lobe involve small areas of the lobe such as the amygdala and hippocampus.[citation needed]

The newer classification gives two types of focal onset seizures, as focal aware and focal impaired awareness.[2]

Focal aware seizures[edit]

Focal aware means that the level of consciousness is not altered during the seizure.[2] In temporal lobe epilepsy, a focal seizure usually causes abnormal sensations only.

These may be:

  • Sensations such as déjà vu (a feeling of familiarity), jamais vu (a feeling of unfamiliarity)
  • Amnesia of a single memory or set of memories
  • A sudden sense of unprovoked fear and anxiety
  • Nausea
  • Auditory, visual, olfactory, gustatory, or tactile hallucinations.
  • Visual distortions such as macropsia and micropsia
  • Dissociation or derealisation
  • Synesthesia (stimulation of one sense experienced in a second sense) may transpire.[8]
  • Dysphoric or euphoric feelings, fear, anger, and other emotions may also occur. Often, the patient cannot describe the sensations.[9]

Olfactory hallucinations often seem indescribable to patients beyond "pleasant" or "unpleasant".[10]

Focal aware seizures are often called "auras" when they serve as a warning sign of a subsequent seizure. Regardless, an aura is actually a seizure itself, and such a focal seizure may or may not progress to a focal impaired awareness seizure.[11] People who experience only focal aware seizures may not recognize what they are, nor seek medical care.[citation needed]

Focal impaired awareness seizures[edit]

Focal impaired awareness seizures are seizures which impair consciousness to some extent:[2] they alter the person's ability to interact normally with their environment. They usually begin with a focal aware seizure, then spread to a larger portion of the temporal lobe, resulting in impaired consciousness. They may include autonomic and psychic features present in focal aware seizures.[citation needed]

Signs may include:[12]

  • Motionless staring
  • Automatic movements of the hands or mouth
  • Confusion and disorientation
  • Altered ability to respond to others, unusual speech
  • Transient aphasia (losing ability to speak, read, or comprehend spoken word)

These seizures tend to have a warning or aura before they occur, and when they occur they generally tend to last only 1–2 minutes. It is not uncommon for an individual to be tired or confused for up to 15 minutes after a seizure has occurred, although postictal confusion can last for hours or even days. Though they may not seem harmful, due to the fact that the individual does not normally seize, they can be extremely harmful if the individual is left alone around dangerous objects. For example, if a person with complex partial seizures is driving alone, this can cause them to run into the ditch, or worse, cause an accident involving multiple people. With this type, some people do not even realize they are having a seizure and most of the time their memory from right before or after the seizure is wiped. First-aid is only required if there has been an injury or if this is the first time a person has had a seizure.[citation needed]

Focal to bilateral seizures or generalized seizures[edit]

Seizures which begin in the temporal lobe, and then spread to involve both sides of the brain are termed focal to bilateral. Where both sides of the brain or the whole brain are involved from the onset, these seizures are known as generalized seizures and may be tonic clonic.[7] The arms, trunk, and legs stiffen (the tonic phase), in either a flexed or extended position, and then jerk (the clonic phase). These were previously known as grand mal seizures.[12] The word grand mal comes from the French term, meaning major affliction.[citation needed]

Postictal period[edit]

There is some period of recovery in which neurological function is altered after each of these seizure types. This is the postictal state. The degree and length of postictal impairment directly correlates with the severity of the seizure type. Focal aware seizures often last less than sixty seconds; focal with impaired awareness seizures may last up to two minutes; and generalized tonic clonic seizures may last up to three minutes.[citation needed] The postictal state in seizures other than focal aware may last much longer than the seizure itself.

Because a major function of the temporal lobe is short-term memory, a focal with impaired awareness seizure, and a focal to bilateral seizure can cause amnesia for the period of the seizure, meaning that the seizure may not be remembered.[citation needed]

Complications[edit]

Depression[edit]

Individuals with temporal lobe epilepsy have a higher prevalence of depression than the general population. Although the psychosocial impacts of epilepsy may be causative, there are also links in the phenomenology and neurobiology of TLE and depression.[13]

Memory[edit]

The temporal lobe and particularly the hippocampus play an important role in memory processing. Declarative memory (memories which can be consciously recalled) is formed in the area of the hippocampus called the dentate gyrus.[citation needed]

Temporal lobe epilepsy is associated with memory disorders and loss of memory. Animal models and clinical studies show that memory loss correlates with temporal lobe neuronal loss in temporal lobe epilepsy. Verbal memory deficit correlates with pyramidal cell loss in TLE. This is more so on the left in verbal memory loss. Neuronal loss on the right is more prominent in non-verbal (visuospatial memory loss).[14][15][16][17][18]

Childhood onset[edit]

After childhood onset, one third will "grow out" of TLE, finding a lasting remission up to an average of 20 years. The finding of a lesion such as hippocampal sclerosis (a scar in the hippocampus), tumour, or dysplasia, on magnetic resonance imaging (MRI) predicts the intractability of seizures.[19]

Personality[edit]

Main article: Geschwind syndrome

The effect of temporal lobe epilepsy on personality is a historical observation dating to the 1800s. Personality and behavioural change in temporal lobe epilepsy is seen as a chronic condition when it persists for more than three months.[20]

Geschwind syndrome is a set of behavioural phenomena seen in some people with TLE. Documented by Norman Geschwind, signs include: hypergraphia (compulsion to write (or draw) excessively), hyperreligiosity (intense religious or philosophical experiences or interests), hyposexuality (reduced sexual interest or drive), circumstantiality (result of a non-linear thought pattern, talks at length about irrelevant and trivial details).[21] The personality changes generally vary by hemisphere.[21]

The existence of a "temporal lobe epileptic personality" and of Geschwind syndrome have been disputed and research is inconclusive.[21]

Causes[edit]

The causes of TLE include mesial temporal sclerosis, traumatic brain injury, brain infections, such as encephalitis and meningitis, hypoxic brain injury, stroke, cerebral tumours, and genetic syndromes. Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality.[12]

Febrile seizures[edit]

Although the theory is controversial, there is a link between febrile seizures (seizures coinciding with episodes of fever in young children) and subsequent temporal lobe epilepsy, at least epidemiologically.[22][23][24][25]

Human herpes virus 6[edit]

In the mid 1980s, human herpesvirus 6 (HHV-6) was suggested as a possible causal link between febrile convulsions and mesial temporal lobe epilepsy. However, although the virus is found in temporal lobe tissue at surgery for TLE, it has not been recognised as a major factor in febrile seizures or TLE.[26][27][28]

Reelin[edit]

Dispersion of the granule cell layer in the hippocampal dentate gyrus is occasionally seen in temporal lobe epilepsy and has been linked to the downregulation of reelin, a protein that normally keeps the layer compact by containing neuronal migration. It is unknown whether changes in reelin expression play a role in epilepsy.[29][30]

Pathophysiology[edit]

Neuronal loss[edit]

In TLE, there is loss of neurons in region CA1 and CA3 of the hippocampus.[31][32] There is also damage to mossy cells and inhibitory interneurons in the hilar region of the hippocampus (region IV) and to the granule cells of the dentate gyrus. In animal models, neuronal loss occurs during seizures but in humans, neuronal loss predates the first seizure and does not necessarily continue with seizure activity.[33][34][35][36][37] The loss of the GABA-mediated inhibitory interneurons may increase the hyperexcitability of neurons of the hippocampus leading to recurrent seizures.[38] According to the "dormant basket cell" hypothesis, mossy cells normally excite basket cells which in turn, inhibit granule cells. Loss of mossy cells lowers the threshold of action potentials of the granule cells.[39]

GABA reversal[edit]

In certain patients with temporal lobe epilepsy it has been found that the subiculum could generate epileptic activity. It has been found that GABA reversal potential is depolarising[40] in the subpopulation of the pyramidal cells due to the lack of KCC2 co-transporter. It has been shown that it is theoretically possible to generate seizures in the neural networks due to down-regulation of KCC2,[41] consistent with the chloride measurements during the transition to seizure[42] and KCC2 blockade experiments.[43]

Granule cell dispersion in the dentate gyrus[edit]

Granule cell dispersion is a type of developmental migration and a pathological change found in the TLE brain which was first described in 1990.[44][45] The granule cells of the dentate gyrus are tightly packed forming a uniform, laminated layer with no monosynaptic connections.[46] This structure provides a filter for the excitability of neurons.[46]

In TLE, granule cells are lost, the structure is no longer closely packed and there are changes in the orientation of dendrites.[45][47] These changes may or may not be epileptogenic. For instance, if the dendrites of granule cells reconnect, it may be in a way (through the laminar planes) that allows hyperexcitability.[34] However, not all patients have granule cell dispersion.[31]: 387–389 

Aberrant mossy fiber sprouting[edit]

Mossy fibers are the axons of granule cells. They project into the hilus of the dentate gyrus and stratum lucidum in the CA3 region giving inputs to both excitatory and inhibitory neurons.[46][48][49]

In the TLE brain, where granule cells are damaged or lost, axons, the mossy fibres, 'sprout' in order to reconnect to other granule cell dendrites. This is an example of synaptic reorganization. This was noted in human tissue in 1974 and in animal models in 1985. In TLE, the sprouting mossy fibres are larger than in the normal brain and their connections may be aberrant. Mossy fibre sprouting continues from one week to two months after injury.[31]: 416–431 [46][50][51][52]

Aberrant mossy fibre sprouting may create excitatory feedback circuits that lead to temporal lobe seizures. This is evident in intracellular recordings.[53] Stimulation of aberrant mossy fibre areas increases the excitatory postsynaptic potential response.[54][55]

However, aberrant mossy fiber sprouting may inhibit excitatory transmission by synapsing with basket cells which are inhibitory neurons and by releasing GABA and neuropeptide Y which are inhibitory neurotransmitters. Also, in animal models, granule cell hyper-excitability is recorded before aberrant mossy fibre sprouting has occurred.[56][57][58][59]

Diagnosis[edit]

Epileptic spike and wave discharges monitored with EEG

The diagnosis of temporal lobe epilepsy can include the following methods:[60]Magnetic resonance imaging (MRI), CT scans, positron emission tomography (PET), EEG, and magnetoencephalography.

Differential diagnosis[edit]

Other medical conditions with similar symptoms include panic attacks, psychosis spectrum disorders, tardive dyskinesia, and occipital lobe epilepsy.[61]

Treatments[edit]

Anticonvulsants[edit]

Many anticonvulsant oral medications are available for the management of temporal lobe seizures. Most anticonvulsants function by decreasing the excitation of neurons, for example, by blocking fast or slow sodium channels or by modulating calcium channels; or by enhancing the inhibition of neurons, for example by potentiating the effects of inhibitory neurotransmitters like GABA.[citation needed]

In TLE, the most commonly used older medications are phenytoin, carbamazepine, primidone, valproate, and phenobarbital. Newer drugs, such as gabapentin, topiramate, levetiracetam, lamotrigine, pregabalin, tiagabine, lacosamide, and zonisamide promise similar effectiveness, with possibly fewer side-effects. Felbamate and vigabatrin are newer, but can have serious adverse effects so they are not considered as first-line treatments.[citation needed]

Up to one third of patients with medial temporal lobe epilepsy will not have adequate seizure control with medication alone. For patients with medial TLE whose seizures remain uncontrolled after trials of several types of anticonvulsants (that is, the epilepsy is intractable), surgical excision of the affected temporal lobe may be considered.[62]

Surgical interventions[edit]

Epilepsy surgery has been performed since the 1860s and doctors have observed that it is highly effective in producing freedom from seizures. However, it was not until 2001 that a scientifically sound study was carried out to examine the effectiveness of temporal lobectomy.[63]

Temporal lobe surgery can be complicated by decreased cognitive function. However, after temporal lobectomy, memory function is supported by the opposite temporal lobe; and recruitment of the frontal lobe.[64][65]Cognitive rehabilitation may also help.[66]

Other treatments[edit]

Where surgery is not recommended, further management options include new (including experimental) anticonvulsants, and vagus nerve stimulation. The ketogenic diet is also recommended for children, and some adults.[67] Other options include brain cortex responsive neural stimulators, deep brain stimulation, stereotactic radiosurgery, such as the gamma knife, and laser ablation.[68]

Effects on society[edit]

The first to record and catalog the abnormal symptoms and signs of TLE was Norman Geschwind. He found a constellation of symptoms that included hypergraphia, hyperreligiosity, collapse, and pedantism, now called Geschwind syndrome.

Vilayanur S. Ramachandran explored the neural basis of the hyperreligiosity seen in TLE using the galvanic skin response (GSR), which correlates with emotional arousal, to determine whether the hyperreligiosity seen in TLE was due to an overall heightened emotional state or was specific to religious stimuli. Ramachandran presented two subjects with neutral, sexually arousing and religious words while measuring GSR. Ramachandran was able to show that patients with TLE showed enhanced emotional responses to the religious words, diminished responses to the sexually charged words, and normal responses to the neutral words. This study was presented as an abstract at a neuroscience conference and referenced in Ramachandran's book, Phantoms in the Brain,[69] but it has never been published in the peer-reviewed scientific press.[70]

A study in 2015, reported that intrinsic religiosity and religiosity outside of organized religion were higher in patients with epilepsy than in controls.[71] Lower education level, abnormal background EEG activity, and hippocampal sclerosis have been found to be contributing factors for religiosity in TLE.[72]

TLE has been suggested as a materialistic explanation for the revelatory experiences of prominent religious figures such as Abraham, Moses, Jesus, Mohammed, Saint Paul, Joan of Arc,[73]Saint Teresa of Ávila, and Joseph Smith. These experiences are described (in possibly unreliable accounts) as complex interactions with their visions; but lack the stereotypy, amnestic periods, and automatisms or generalized motor events, which are characteristic of TLE. Psychiatric conditions with psychotic spectrum symptoms might be more plausible physical explanation of these experiences.[74] It has been suggested that Pope Pius IX's doctrine of the immaculate conception was influenced by his forensically-diagnosed[jargon] partial epilepsy.[75]

In 2016, a case history found that a male temporal lobe epileptic patient experienced a vision of God following a temporal lobe seizure, while undergoing EEG monitoring. The patient reported that God had sent him to the world to "bring redemption to the people of Israel".[76] The purported link between TLE and religiosity has inspired work by Michael Persinger and other researchers in the field of neurotheology. Others have questioned the evidence for a link between temporal lobe epilepsy and religiosity.[70][77]

References[edit]

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Sours: https://en.wikipedia.org/wiki/Temporal_lobe_epilepsy

Lobe epilepsy temporal

Temporal Lobe Epilepsy

What Is Temporal Lobe Epilepsy?

Kids with temporal lobe epilepsy have seizures that start in one of the temporal lobes of the brain. The temporal lobes are on the sides of the brain, behind the temples. This area is involved in controlling emotions and short-term memory.

 Kids who have the condition usually start having seizures between age 10 to the late teen years.

What Happens in Temporal Lobe Epilepsy?

The seizures in temporal lobe epilsepsy are focal seizures. Focal seizures begin on one side of the brain.

  • If someone stays aware during a seizure, it is called a focal onset aware seizure (formerly called a simple partial seizure).
  • If someone loses awareness during the seizure, it is called a focal onset impaired awareness seizure (formerly called a complex partial seizure).

What Do Seizures Look Like in Temporal Lobe Epilepsy?

An aura is a type of focal onset aware seizure. Symptoms of an aura can include:

  • déjà vu (a feeling of already having been in the present situation)
  • a smell, taste, sound, or vision
  • an emotion (such as fear)
  • nausea or a rising sensation in the belly

Someone having a focal onset impaired awareness seizure may stare, rub their hands, or smack their lips. It may be hard to speak or understand language during the seizure.

Sometimes a focal seizure can develop (or generalize) into a seizure that involves both sides of the brain. This is called a focal to bilateral tonic-clonic seizure. With this type of seizure, the whole body jerks with forceful movements.

What Causes Temporal Lobe Epilepsy?

Infections, brain injury, a tumor, genetic mutations, or changes in brain structure all can cause temporal lobe epilsepsy. Babies who have a febrile seizure (caused by a high fever) that lasts for 15 minutes or longer have a higher risk for developing the condition later on.

How Is Temporal Lobe Epilepsy Diagnosed?

A pediatric neurologist (a doctor who treats brain, spine, and nervous system problems) will diagnose the condition by doing tests such as:

How Is Temporal Lobe Epilepsy Treated?

Seizures usually get better with medicine. If medicines don't control the seizures, doctors may recommend neurostimulation (using a device to stimulate nerves to stop seizures) or surgery.

How Can I Help My Child?

Kids with temporal lobe epilepsy can lead a normal life. To help your child:

  • Make sure your child takes medicines as prescribed.
  • Tell the doctor if you don't think a medicine is working or notice anything different.

Some kids have trouble with memory and mood. Get help from specialists and therapists early on to support academic, social, and emotional success.

It's important to keep your child safe during a seizure. Make sure that other adults and caregivers (family members, babysitters, teachers, coaches, etc.) know what to do if one happens.

Often, temporal lobe epilepsy is a lifelong condition. When it's time, help your child move to adult health care.

What Else Should I Know?

If your child has epilepsy, reassure them that they’re not alone. Your doctor and the care team can answer questions and offer support. They also might be able to recommend a local support group. Online organizations can help too, such as:

Sours: https://kidshealth.org/en/parents/temporal-lobe-epilepsy.html
Temporal Lobe Epilepsy Seminar 1: Overview

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