Temporal lobe seizure

Alternative names
TLE; Seizure - temporal lobe

Definition
This type of seizure involves a temporary movement disturbances, unusual sensations, or various other symptoms. It arises from abnormal electrical activity in the temporal lobe on one or both sides of the brain.

Causes, incidence, and risk factors

A seizure is an episode of abnormal electrical activity in the brain that can involve loss of consciousness or reduction of consciousness, involuntary movements, and overwhelming sensations.

Temporal lobe seizures can affect people of any age, and can occur as a single episode or can be repeated as part of a chronic (ongoing) condition. (See seizure disorder.)

Information in the brain is transmitted from nerve cell to nerve cell by an electrochemical process. Certain patterns of electrical activity can cause seizures - episodes when electrical signals spread in abnormal patterns within the brain. This process can be detected by an electroencephalograph (EEG).

Given sufficient circumstances (such as exposure to certain drugs, high fever, or electrical stimulation), anyone can have a seizure.

Temporal lobe seizures commonly result from damage to specific areas in the temporal lobe of the brain. This damage includes scarring called mesial temporal sclerosis. Causes can include traumatic injury, infection, damage to a portion of the temporal lobe due to lack of oxygen, brain tumors, genetic syndromes, and lesions of any sort.

Because the temporal lobe is involved in processing emotion and sensations, seizures in this area may begin with feelings of fear, feelings of joy (sometimes with religious associations and the sensation of a “presence”), recall of certain music, or smells and other unusual symptoms.

Symptoms
The early warning symptoms (called an aura) include:

     
  • Abnormal sensations  
  • Epigastric sensations (“a funny feeling in my gut,” “stomach rising,”)  
  • Hallucinations or illusions (vision, smells, tastes, or other sensory illusions)  
  • Sensation of deja vu, recalled emotions or memories  
  • Sudden, intense emotion not related to anything occurring at the time  
  • Consciousness maintained during the seizure or spell (partial)  
  • Consciousness reduced or lost during the seizure or spell (partial complex)

Movement disturbances include:

     
  • Abnormal mouth behaviors       o Lip smacking       o Chewing or swallowing without cause       o Profuse salivation “slobbering”  
  • Abnormal head movements       o Forced turning of the head       o Forced turning of the eyes       o Usually in the direction opposite of the location of the lesion  
  • Repetitive movements, such as picking at clothing  
  • Rhythmic muscle contraction and relaxation (rare) - affecting one side of the body, one arm, leg, part of face, or other isolated area

Abnormal sensations include:

     
  • Numbness, tingling, crawling sensation  
  • Occurring in only one part of the body or spreading  
  • Preceding motor symptoms  
  • Sensory hallucinations (visual, hearing, touch, etc.)

Autonomic symptoms include:

     
  • Abdominal pain or discomfort  
  • nausea  
  • Sweating  
  • Flushed face  
  • Dilated pupils (eyes)  
  • Rapid heart rate/pulse

Other symptoms include:

     
  • Changes in vision, speech, thought, awareness, personality  
  • Loss of memory (amnesia) regarding events around the seizure (partial complex seizure)

Signs and tests
Diagnosis of temporal lobe seizure is suspected primarily on the basis of the symptoms presented and the results of testing. Diagnosis may include a complete physical examination, including a detailed neuromuscular examination, which may or may not be normal.

     
  • An EEG (electroencephalograph, recording of brain electrical activity) shows characteristic changes confirming partial (focal) seizures and may show the focus (location of the cause).  
  • A head CT scan or a Cranial MRI may show the location and extent of the causative lesion.  
  • A lumbar puncture may be necessary if there is suspicion of an infection causing the seizure.

Treatment

The goals of treatment are to perform emergency measures, if necessary, and to reduce the incidence of future seizures.

Emergency treatment may not be required, unless the seizure becomes generalized or consciousness is lost. First-aid measures should be performed as appropriate, including protection from injury, prevention of breathing vomit or mucus into the lungs, and airway protection or assistance with breathing.

Record details of the seizure and report them to the health care provider. Important details include date and time of the seizure, how long it lasted, which body parts were affected, type of movements or other symptoms, possible causes and other factors which provide information about the episode (such as what immediately preceded it).

The treatment of causes may stop the occurrence of seizures. This may include medical treatment of seizure disorders like Epilepsy, surgical repair of tumors, or brain lesions and other treatments.

Oral anticonvulsants (anti-seizure medications) are used to prevent or reduce the number of future seizures. Response is individual, and the medication and the dosage may have to be adjusted repeatedly.

Multiple, repeated seizures are usually treated with long-term use of an antiepileptic drug.

Follow-up includes reviewing the need for drugs at least yearly. Drugs may be required indefinitely. Plasma drug-level monitoring is important to continue control of seizures and reduce side effects.

Pregnancy, lack of sleep, skipping doses of medications, use of recreational drugs (including alcohol), or illness may cause seizures in a person with a previously well-controlled seizure disorder.

Use of informational jewelry or cards (such as Medic-Alert or similar) that indicate a seizure disorder may be advised to aid in obtaining prompt medical treatment if a seizure occurs.

Expectations (prognosis)

Seizures can occur as a single event or be recurrent. Seizures that recur with no precipitating factors are most commonly a chronic, lifelong condition termed Epilepsy.

Seizures that occur singly or in a discrete cluster are commonly caused by an acute condition, such as brain injury. They may occur secondary to an isolated incident, but can then develop into a chronic seizure disorder. Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop.

Serious injury can occur if seizure occurs while during driving or when operating dangerous equipment. Each state has different policies on driving restrictions. Swimming and bathing without supervision are also not recommended. Contact sports are also not advisable. Therefore, these activities may be restricted for persons with poorly controlled seizure disorders.

Complications

     
  • Progression to generalized seizures  
  • Recurrent seizures (Epilepsy)  
  • Prolonged seizures, closely occurring seizures (status epilepticus)  
  • Injury from falls, bumps, biting self, etc.  
  • Injury from seizure occurring during driving or operating machinery  
  • Breathing fluid, Pneumonia  
  • Permanent brain damage (stroke or other damage)  
  • Side effects of medications (with or without observable symptoms)

Calling your health care provider
Go to the emergency room or call 911 if:

     
  • This is the first time the person has had a seizure or this is a new type or prolonged seizure.  
  • This is an emergency situation.  
  • If sequential seizures occur, or repeat seizure activity where consciousness is not regained in between (status epilepticus) is an emergency situation.  
  • Any new symptoms occur, including possible side effects of medications, such as changes in mental status (drowsiness, restlessness, confusion, sedation, or others), nausea or Vomiting, rash, loss of hair, tremors or abnormal movements, problems with coordination.

Prevention
Treatment of any lesions or disorders may reduce the seizures. In many cases, Epilepsy is caused by a genetic disorder and may not be preventable.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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