Temporal Lobe Epilepsy (TLE)
Temporal Lobe Epilepsy (TLE) is the most prevalent type of epilepsy, a neurological disorder characterized by recurrent seizures due to abnormal electrical activity in the brain. TLE specifically originates in the temporal lobe, which is involved in processing emotions and short-term memory. It is classified into two types based on the seizure origin: medial TLE, which arises from the inner region near the hippocampus and accounts for about 80% of cases, and neocortical TLE, which originates from the outer region. Seizures can be categorized as simple partial or complex partial, depending on whether the person is conscious during an episode. Individuals may experience auras—pre-seizure sensations such as déjà vu or anxiety—and various physical symptoms during seizures, including twitching and confusion afterward.
TLE can manifest at any age, but it often appears during late adolescence or early adulthood, with a higher prevalence in women due to hormonal factors. While the exact cause remains unknown, potential risk factors include brain injuries, infections, and genetic predisposition. Diagnosis typically involves neurological assessments, including MRI and EEG tests. Treatment options range from anti-epileptic medications to various surgical interventions aimed at reducing seizure frequency. Living with TLE may necessitate certain lifestyle adjustments to ensure safety, particularly regarding activities that could lead to injury during a seizure, such as driving or swimming alone.
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Temporal Lobe Epilepsy (TLE)
Temporal lobe epilepsy (TLE) is the most common form of epilepsy. Epilepsy is a brain disorder characterized by seizures. Seizures are caused by electrical activity in the brain. They affect a person in several ways. They can cause shaking, blackouts, and confusion, among other symptoms. Like most forms of epilepsy, the exact cause of TLE has not been determined.
Background
The temporal lobe (TL) of the brain deals with emotions and processes and stores short-term memories. Two types of TLE exist and are classified by which part of the TL the seizures originate from. One begins in the medial, or inner, region of the TL, in the region of the hippocampus. The second begins in the neocortical, or side. Medial TLE is more common and accounts for nearly 80 percent of all TL seizures.
TL seizures are partial seizures because they affect only part of the brain. Generalized seizures affect the entire brain. If a person loses consciousness during a TL seizure, this is called a complex partial seizure. If a person remains awake, this is called a simple partial seizure.
Several warning signs and symptoms indicate TLE right as it is about to cause a seizure. These signs are called auras and can last from seconds to minutes prior to a seizure. People may feel strange and experience déjà vu, euphoria, or anxiety. They may vividly recall old memories. They may also get a rising feeling in the stomach (butterflies) or have gastrointestinal upset. Some people may experience hallucinations of events, people, smells, sounds, and tastes. Not all people who have TL seizures experience auras, and many who do may not remember the episodes.
People who experience TL seizures have different reactions. Some people may have intense physical reactions, while other people may not show any physical signs of having a seizure. During the seizure, patients may blackout or remain conscious. Their bodies may twitch and make repetitive, uncontrollable movements. People may chew, smack their lips, stare, or swallow. They may fumble with their fingers or rub their hands together. Other people may speak gibberish or have a change in posture.
Afterward, people may experience confusion and be unaware of what happened. They may have language problems or feel fatigued. Very rarely people will experience a severe seizure known as a generalized tonic-clonic, or grand mal, seizure, which can cause physical convulsions and unconsciousness.
TLE occurs in nearly 60 percent of all patients with epilepsy. It can occur at any age but most commonly shows up when a person is in his or her late teens or early twenties. Some people are more at risk for developing TLE. More women than men may experience TL seizures. This is because women have hormonal imbalances during their menstrual cycles and during ovulation. These imbalances may cause seizures.
The exact cause of TLE is unknown. Several potential risk factors include traumatic brain injuries; infections such as meningitis or encephalitis; stroke; genetics; and brain issues such as scarring in the TL, tumors, deformities of the blood vessels, and abnormal electrical activity. Patients who have had febrile seizures, or seizures triggered by a high fever, are at an increased risk of developing TLE.
Overview
A physician can diagnose TLE by witnessing a seizure or by receiving a detailed description of what happened during the seizure. Most times, a third-party witness can offer an account. Physicians will perform several tests. One of these is magnetic resonance imaging (MRI). During this test, the brain is scanned to look for abnormalities. These can indicate that a patient has TLE.
An electroencephalogram (EEG) measures the electrical activity within the brain. Sharp waves seen near the vicinity of the temporal lobe may indicate a patient has TLE.
Many patients are prescribed anti-epilepsy drugs to treat TLE. These may have adverse side effects, such as dizziness, fatigue, and weight gain. They may interfere with certain medications such as birth control pills.
Some people do not react well to anti-epilepsy drugs or are resistant to them. They have surgical options. In vagus nerve stimulation, a device is implanted in the chest. The device has wires connected to the vagus nerve in the neck. These wires stimulate the nerve to reduce seizures.
With responsive neurostimulation, a device is implanted into the brain either on its surface or in the tissue. The device is attached to a battery-controlled generator that is connected to the skull. The device tries to stop seizures by stimulating the area where the seizure is occurring in the brain.
In deep brain stimulation, electrodes are implanted into the thalamus of the brain. They transmit signals to stop a seizure as it occurs.
People with TLE may experience memory loss or mood changes. This can impair a person's quality of life. Severe mood changes can increase a person's risk of death.
While medication and surgery are used to treat TLE, the condition can pose risks to those living with it and others around them. For example, a person with TLE may have a seizure when driving a vehicle and cause an accident. To avoid further injury during a seizure, people with TLE should avoid certain activities or take precautions when performing them. They should not swim alone, and they should always use life preservers. They should shower instead of taking baths to avoid drowning. They should avoid working on a ladder or roof to prevent falls. They should wear helmets when riding a bicycle. Some people with TLE may be restricted from driving or operating machinery in certain places.
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