Temporal Lobe Epilepsy

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Temporal Lobe Epilepsy also known as TLE is is characterized by abnormal electrical activity in the temporal lobe region of the brain. It is a type of focal epilepsy, and is characterized by recurrent seizures. Approximately 50% of patients with epilepsy have partial epilepsy. They are a group of medical illness or disorders in which humans and animals experience recurrent epileptic seizures.

What Temporal Lobe Epilepsy (TLE) means is that the seizures arise in the temporal lobe of the brain. Experiences during temporal lobe seizures vary from patient to patient based on intensity and quality. They are many times so feeble that thry go unnoticed, and other times, they are too harsh making a person feel fear, pleasure, or unreality. Temporal lobe epilepsy, for example, can lead to sudden outbursts of unexpected anger and agitation or lot other times, it is characterized by aura-like phenomena.

Types and Causes of Temporal Lobe Epilepsy

Two main types of TLE are internationally recognized. They are as follows:

• Mesial temporal lobe epilepsy (MTLE) - It arises in the hippocampus, parahippocampal gyrus and amygdala all of which are inside the inner aspect of the temporal lobe.
• Lateral temporal lobe epilepsy (LTLE) - It arises in the neocortex on the outer surface temporal lobe of the brain.

Symptoms and Prognosis of Temporal Lobe Epilepsy

Below are some of the symptoms of TLE:

• Hamartomas
• Gliomas
• Vascular malformations (i.e. arteriovenous malformation, cavernous angioma)
• Cryptogenic: A cause is presumed but has not been identified
• Idiopathic (rare)
• A complex partial seizure may evolve to a secondarily generalized tonic-clonic seizure.
• A careful history from the patient or an observer is needed to differentiate between complex annd partial seizure.
• Patients usually experience a postictal period of confusion, which distinguishes TLE from absence seizures.

For most people, the seizures of TLE can be completely or at least mostly controlled with the medications for partial seizures.

Treatment of Temporal Lobe Epilepsy

About half of patients suffering from TLE become seizure free with medical treatment. Seizure-free state 2 years after anterior temporal lobectomy is predictive of long-term seizure-free outcome

1. For treatment of temporal lobe epilepsy specifically, the most commonly used AEDs are phenytoin, carbamazepine, valproate and phenobarbital.
2. Newly discovered drugs like gabapentin, topiramate, Levetiracetam and lamotrigine, indicates similar effects coupled with fewer side-effects.
3. Vagus Nerve Stimulation can also be beneficial in cases where temporal lobectomy is not recommended or has failed. At the NYU CEC we offer surgical treatments for TLE tailored to each patient.

Patients with refractory temporal lobe epilepsy have an enhanced risk of sudden death that is 50 times greater than that in the general population. Below are some medicines recommended.

1. Zonegran (zonisamide)
2. Keppra (levetiracetam)
3. Neurontin (gabapentin)
4. Lamictal (lamotrigine)
5. phenobarbital
6. Gabitril (tiagabine)