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Temporal Lobe Seizure

Definition


Disease: Temporal Lobe Seizure Temporal Lobe Seizure
Category: Neurological diseases

Disease Definition:

In the part of the brain where emotions are processed along with short term memory and fight or flight reactions is where a temporal lobe seizure begins. During a seizure, the patient may experience emotional fluctuations ranging from déjà vu to sensory hallucinations or from excess happiness to horror.

 

Though its exact cause may not always be identified, but this condition has a high possibility of resulting from scars or anatomical defects. This condition is often immune to anti-seizure medications. In case only one of the two temporal lobes is defected, surgical removal of the affected region may relieve the patient from the seizures.
 

Work Group:


Symptoms, Causes

Symptoms:

These seizures are sometimes preceded by a phenomenon called aura, which is a weird sensation or emotion that warns of the upcoming seizure. Not all patients remember the aura experience. The aura is a small seizure which doesn’t cause irresponsive behavior and diminished consciousness. A patient in aura may experience:

 

  • Deja vu
  • Abrupt sensory illusions (smell or taste)
  • Uneasiness in the abdomen
  • Abrupt fear with no reason

 

Temporal lobe seizures may rarely cause patients to lose consciousness, but they usually do not remember what happened due to their loss of awareness to the surrounding environment. Seizures may range in duration from a half minute to two minutes. Symptoms are summarized as follows:

 

  • Impaired awareness to surroundings
  • Incoherent movement of the fingers
  • Swallowing or chewing repeatedly
  • Staring
  • Smacking lips

 

After the seizure is over, the patient may experience:

 

  • Unawareness of the seizure itself
  • Unawareness of events during the seizure
  • Temporary speech impediment and mental disturbance

 

In some severe cases, a transition occurs and a temporal lobe seizure is transformed into a grand mal (tonic-clonic) seizure, which is characterized by fainting and convulsions. 50% of temporal lobe seizure patients never reach to the point of grand mal seizure. Should the frequency of the seizures rise with no apparent reason or new symptoms are noticed in a seizure, medical advice should be sought. Emergency medical services should be contacted when a seizure doesn’t end within five minutes. In the case of suspecting a transition to a grand mal seizure (muscle contractions and incoherent movements), emergency medical services should be contacted immediately. Until the arrival of the ambulance:

 

  • The patient should lie down on one side, and the head should be supported with a pillow.
  • Any tight garment around the neck should be loosened
  • The tongue can’t be swallowed. Keeping this in mind, nothing should come in contact with the patient’s mouth, since objects can be bitten or inhaled.
  • The patient shouldn’t be restrained. However, he/she should be searched for a medical alert bracelet, which may indicate some information and an emergency contact person.
     

Causes:

The human brain is an electrically active organ that generates a variety of electrical signals. If, for some reason, neurons have lost synchronization, the result will be a convulsion or a seizure. This phenomenon can occur in any part of the brain and the results vary according to its location. Temporal lobe seizure occurs when there’s a mis-synchronization in the temporal lobe. This case can be caused by:

 

  • Encephalitis, meningitis or similar infections
  • Traumatic injury
  • Cerebral blood circulation problems
  • Family history
  • Damage from oxygen starvation
  • Brain tumors
  • Any scaring in the temporal lobe in a region called hippocampus
  • Stroke
     

Complications

Complications:

When seizures recur over an extended period of time, the hippocampus can shrink which is the part of the brain that is in charge of learning and memory. Memory problems may result in the case of brain cell loss in this area.
 

Treatments:

While children are growing, they may overcome temporal lobe seizures. But this is not always the case, especially when defects or scars are detected while using brain scans.  This is especially troublesome due to the need for surgery and resistance of the scars to medication.

 

Medications:

Several types of medications are suitable to treat temporal lobe seizures such as:

 

  • Oxcarbazepine
  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Levetiracetam
  • Tiagabine
  • Valproic acid
  • Zonisamide
  • Felbamate
  • Lamotrigine
  • Gabapentin
  • Topiramate
  • Pregabalin

 

Usually, medication alone is not sufficient to control seizures in many people, and these medications have side effects such as weakness and lightheadedness.

 

Surgery:

Although surgical operations to treat temporal lobe seizures are characterized by high success rates according to the initial cause of the condition, and range from 65% to 90%, but it is not recommended when the defected region contains vital brain functions, or when there are multiple defected regions. Some preparations have to be made before surgery, like brain scans with magnetic resonance and examinations of seizures via video recording and electroencephalogram. Modern radiosurgery research has proved the efficiency of gamma knife in damaging the region of the brain that triggers the seizures, by controlling the exact amount of radiation. This method is still an experimental one since its direct and side effects are virtually unknown right after the operation.

 

It is always a safe call to get a second opinion before making the surgery decision, since the experience of the surgeon plays a great role in the procedure and may even permanently affect the patient’s cognitive abilities. After surgery, medication is still needed to prevent seizures, but with lesser dosage.

 

Vagus nerve stimulation:

In case medications fail or cause serious side effects, a device is implanted in the chest under the collarbone called vagus nerve stimulator, which is wired to the vagus nerve in the neck. Magnetically activated, it can be programmed to meet the operation requirements.

 

PREGNANCY AND SEIZURES:

Women with seizures may experience a normal pregnancy period, but it’s a safe practice to pre-plan the pregnancy with a physician who may reduce medication prior to pregnancy or even move to another medication if need be. It is recommended that pregnant women avoid valproate since it may affect the child.

 

CONTRACEPTION AND ANTI-SEIZURE MEDICATIONS:

Some anti-seizure medications can interfere with the function of oral contraceptive drugs. Medical evaluation is needed to explore potential risks and find solutions.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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Expert's opinion:

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