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Temporal lobe seizureBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/temporal-lobe-seizure/DS00266
Temporal lobe seizures are seizures that originate in the two temporal lobes of your brain.
The temporal lobes process emotions, fight-or-flight reactions, 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, fear, panic and deja vu.
During a temporal lobe seizure, you may remain partially conscious. Or, if the temporal lobe seizure is more intense, you may be unresponsive, even though you look awake. You also may make repetitive movements of your lips and hands.
Temporal lobe seizures may stem from an anatomical defect or scar. But the cause often remains unknown.
Temporal lobe seizures may be resistant to anti-seizure medications. Surgery may be an option for some people who don't respond to medication.
An unusual sensation, known as an aura, may precede a temporal lobe seizure, acting as a warning. Not everyone who has temporal lobe seizures experiences auras, and those who have auras may not remember them. The aura is actually a small seizure itself — one that has not spread into an observable seizure that impairs consciousness and ability to respond. Examples of auras include:
- A sudden sense of unprovoked fear
- A deja vu experience — a feeling that what's happening has happened before
- The sudden occurrence of a strange odor or taste
- A rising sensation in the abdomen
People who have temporal lobe seizures can remain partially conscious during a seizure, but they also may lose awareness of their surroundings and often don't remember what happened.
A temporal lobe seizure usually lasts 30 seconds to two minutes. Characteristic signs and symptoms of temporal lobe seizures include:
- Loss of awareness of surroundings
- Lip smacking
- Repeated swallowing or chewing
- Unusual finger movements, such as picking motions
After a temporal lobe seizure, you may have:
- A brief period of confusion and difficulty speaking
- Inability to recall the events that occurred during the seizure
- Unawareness of having had a seizure until someone else tells you
In extreme cases, what starts as a temporal lobe seizure evolves into a grand mal (tonic-clonic) seizure — featuring convulsions and a loss of consciousness.
When to see a doctor
Seek medical advice in these circumstances:
- If you think you're having seizures — early diagnosis is important
- When the number or severity of seizures increases significantly without explanation
- When new signs or symptoms of seizures appear
Seek emergency medical care if:
- A seizure lasts more than five minutes
- The person doesn't recover completely or as quickly as usual after the seizure is over
- Rhythmic muscle contractions or jerky movements occur, which may indicate a grand mal seizure is developing
If it appears a grand mal seizure may be developing:
- Call for medical help immediately.
- Gently roll the person onto one side and put something soft under his or her head.
- Loosen tight neckwear.
- Don't put anything in the mouth — the tongue can't be swallowed, and objects placed in the mouth can be bitten or inhaled.
- Don't try to restrain the person. Look for a medical alert bracelet, which may indicate an emergency contact person and other information.
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Often, the cause of temporal lobe seizures remains unknown. However, they can be a result of:
- Traumatic brain injury
- Infections, such as encephalitis or meningitis, or history of such infection
- A process that causes scarring (gliosis) in a part of the temporal lobe called the hippocampus
- Inflammatory disorders of the brain
- Injury due to a previous lack of oxygen
- Blood vessel malformations in the brain
- Brain tumors
- Genetic syndromes
During normal waking and sleeping, your brain cells produce varying electrical activity. If the electrical activity in many brain cells becomes abnormally synchronized, a convulsion or seizure may occur. If this happens in just one area of the brain, the result is a partial seizure. When this occurs in an area of the brain known as the temporal lobe, it's called a temporal lobe seizure.
Over time, repeated temporal lobe seizures can cause the part of the brain that's responsible for learning and memory to shrink. This area is called the hippocampus. Brain cell loss in this area may cause memory problems.
Preparing for your appointment
You'll likely start by seeing your family doctor or a general practitioner, then you'll likely be referred to a doctor who specializes in nervous system disorders (neurologist).
It's good to prepare for your appointment. Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.
What you can do
- Write down any symptoms you or your child has experienced, including any that may seem unrelated to the reason for which you scheduled the appointment. Make particular note of the different kinds of seizures experienced. For example, do some affect the left side more than the right or vice versa? Do some affect speech and others not?
- Make a list of all medications, vitamins and supplements you or your child is taking and the dosages used. Write down the reasons any were discontinued, whether because of side effects or lack of effectiveness.
- Ask a family member to come with you to the doctor, because it's not always easy to remember everything you've been told during your appointment. Also, since memory loss can happen during seizures, many times an observer is able to better describe the seizures than is the person who's had the seizures.
- Write down questions to ask your doctor.
Preparing a list of questions for your doctor will help you make the most of your time together. For temporal seizure, some basic questions to ask your doctor include:
- Is the diagnosis epilepsy?
- Will more seizures occur? Will different types of seizures occur?
- What kinds of tests are needed? Do these tests require any special preparation?
- What treatments are available, and which do you recommend?
- What types of side effects can I expect from treatment?
- Is surgery a possibility?
- Are there any activity restrictions?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed materials I can take home with me? What websites do you recommend?
Don't hesitate to ask any other questions that occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did you or your child begin experiencing symptoms?
- Did you notice any unusual sensations before the seizures?
- How often do the seizures occur?
- Can you describe a typical seizure?
- How long do the seizures last?
- Do the seizures occur in clusters?
- Do they all look the same or are there different seizure behaviors you or others have seen?
- What medications have you or your child tried? What doses were used?
- Have you tried any medication combinations?
- Have you noticed any seizure triggers, such as sleep deprivation or illness?
Tests and diagnosis
Your doctor will need a detailed description of the seizures, preferably from a witness, because most people who have temporal lobe seizures don't remember the episodes.
If you've had a seizure, your doctor usually will perform a neurological exam that tests:
- Muscle tone
- Muscle strength
- Sensory function
He or she may also ask questions to assess your thinking, judgment and memory.
Blood tests and scans
Blood tests may be ordered as appropriate to check for problems that could be causing or triggering the seizures.
Your 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're having.
In some cases, your doctor may recommend video-EEG monitoring in the hospital. This allows your doctor to compare — second by second — the behaviors 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 the most appropriate treatment options, and can help make sure that the diagnosis of seizures 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 immobilized 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 problem, inform your doctor before the study.
Single-photon emission computerized tomography (SPECT). This type of test is sometimes used in people being evaluated for epilepsy surgery when the area of seizure onset is unclear on MRIs or EEGs. SPECT imaging requires two scans — one during a seizure and one during a nonseizure period, each performed on separate days. Radioactive material is injected for both scans. The seizure and nonseizure scan are then compared on a computer to see 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 during surgery planning to possible areas of seizure onset.
Treatments and drugs
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|Vagus nerve stimulation|
Numerous medications are available to treat temporal lobe seizures, including:
- Carbamazepine (Carbatrol, Tegretol, others)
- Phenytoin (Dilantin, Phenytek)
- Valproic acid (Depakene, Stavzor)
- Oxcarbazepine (Trileptal)
- Lamotrigine (Lamictal)
- Gabapentin (Gralise, Neurontin)
- Topiramate (Topamax)
- Zonisamide (Zonegran)
- Levetiracetam (Keppra)
- Tiagabine (Gabitril)
- Pregabalin (Lyrica)
- Felbamate (Felbatol)
- Lacosamide (Vimpat)
- Vigabatrin (Sabril)
However, many people don't achieve seizure control with medications alone, and side effects, including fatigue, weight gain and dizziness, are common. In particular, the FDA has issued a warning that the drug Lamictal has been associated with a type of meningitis. Discuss possible side effects with your doctor when deciding about treatment options.
Success rates for temporal lobe epilepsy surgery range from about 60 to 90 percent. Success, as defined in surgical outcome studies, means having no seizures or far fewer seizures. It doesn't mean discontinuing medication.
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
- Where your seizures originate can't be identified
Preparing for surgery likely involves talking to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering. You may also want to request a second opinion before having surgery.
Before surgery, you'll need:
- A comprehensive evaluation
- MRI scans of your brain
- Observation of your seizures in a hospital-based monitoring unit using video recordings and EEG
In some cases, surgery to implant intracranial electrodes may be necessary before finally deciding about temporal lobe surgery.
After surgery, most people need to continue taking medication to help ensure that seizures don't recur. However, successful surgery often means being able to reduce the dose, and some people are able to stop taking medication. Infrequently, surgery can lead to neurological problems. Discuss the possible risks with your surgeon before making final decisions about surgery.
Researchers have been investigating the use of radiosurgery, which uses a Gamma Knife to deliver a precise dose of radiation to the damaged portion of the brain. This procedure is still considered experimental, and the anti-seizure effects as well as any side effects of the procedure may be delayed for one to two years.
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 program and can be activated with a magnet. The device doesn't detect seizures. It's usually well tolerated, but it's not a replacement for medication.
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, the birth defect risk is about twice that of pregnant women who don't require seizure medications. 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.
The risk of birth defects differs, depending on the seizure medication, and is considered to be higher in women taking more than one drug. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby. If your seizures can't be well controlled with any 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 other forms of contraception need to be considered.
Lifestyle and home remedies
Certain activities could be dangerous if you have a seizure while doing them. Activities include:
- Swimming. If you go in water, don't go alone and 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 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're under control, seizures can affect your life. Temporal lobe seizures may present even more of a coping challenge because people may not recognize the unusual behavior 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. Poor self-esteem, depression and suicide are increased in people who have repeated seizures.
You may find it helpful to talk with other people who are in the same situation you are. Besides offering support, they may also have advice or tips for coping that you haven't considered. The Epilepsy Foundation has a network of support groups, as well as online forums for teens and adults who have seizures and for parents of children who have seizures. You can reach the foundation at 800-332-1000 or visit the foundation website. You can also ask your doctor if he or she knows of any support groups in your area.
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