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Temporal Lobe Epilepsy

The temporal lobe is a region of the cerebral cortex on both hemispheres of the brain located approximately at the level of the ears. They are involved in recognition and processing of sound, language and smells and play a key role in the formation of memory.

The features of temporal lobe epilepsy are extremely diverse. Temporal lobe seizures are often accompanied by strange sensations, sweating, flushing, vertigo, epigastric sensations, taste, and hearing of sounds or melodies, nausea, hallucinations or feelings of déjà vu. Thoughts, speech and emotions of the patients may also be affected. Often people find it difficult to describe these seizures and they may be associated with fear or anxiety. The symptoms may be present in isolation. Often seizures are stereotyped lasting up to several minutes with decreased responsiveness and automatisms, or automatic behavior can occur. In children, automatisms tend to be less complex than in adults, usually consisting of mouth movement or non-purposeful hand gestures.

People with temporal lobe epilepsy may experience memory and learning problems. Someone with a problem in the area of the lateral left temporal lobe may have difficulty with processing speech. They might know the correct word but be unable to say it; they may confuse similar sounds and words or put letters in the wrong order.

The most common type of temporal lobe epilepsy arises from the internal part of the temporal lobe where the amygdala and hippocampus are situated, and which is mostly related to mesial temporal sclerosis. The main function of the hippocampus seems to be processing short-term memory and spatial information whereas the amygdala plays an important part in memory consolidation, processing and storing of emotional reactions.

How common is it?

Approximately 60% of focal (partial) localisation related epilepsies in adults begin in the temporal lobes. Most commonly caused by mesial temporal sclerosis, followed by tumours, vascular malformations, focal cortical dysplasia; it may have been caused by infections or trauma resulting in scarring of the brain or by genetic disposition. It may appear at any age, depending on cause, but usually in childhood or adolescence.

Epilepsy and temporal lobe seizures

Mesial temporal lobe seizures:

Often a strong family history of epilepsy is present. Seizures typically occur during infancy and childhood and disappear for several years before they return in adolescence. Focal (partial) seizures are typically characterised by a rising epigastric discomfort, or abdominal-chest sensations. They can also be characterised by irritating senses of smell or taste, autonomic symptoms (flushing, sweating, changes of heart rate), emotional changes (rising fear or anxiety, anger, depression, euphoria) or memory symptoms (déjà vu or jamais vu – a sense of familiarity or unfamiliarity respectively). There can be loss of awareness and little or no memory of the event. There can also be motor arrest (where the person is motionless) and staring for several seconds, often followed by automatisms like lip-smacking, licking, or chewing. Fiddling and fumbling with objects, restlessness, walking or vocalisation (automatic uttering of words) can occur.

Lateral temporal lobe seizures:

These seizures have similar characteristics, although they may include visual and auditory hallucinations (seeing figures, distortion of objects or hearing melodies, sounds) or vertigo.

A focal (partial) seizure may evolve into a secondarily generalised tonic clonic (convulsive) seizure. After focal and secondarily generalised seizures, confusion, headache and sleepiness may be observed, lasting several minutes to hours. Psychosis with paranoid features like visual or auditory hallucinations can occur, as well as depression. Seizures may occur randomly, at intervals or in clusters. For many patients, their seizures are controlled by medication, although one third of new cases may be medication resistant. Surgery may be an option in particular cases (symptomatic epilepsy) depending on the cause. Further treatment alternatives for medication-resistant epilepsy may be the ketogenic diet or vagus nerve stimulation.

Some helpful tips for parents:

  • Consistent routine.
  • Keep rules short and to the point.
  • Issue instructions a bit at a time.
  • Use repetition.
  • Use visual clues if the child has left temporal lobe epilepsy.
  • Redirect rather than comfort.
  • Allow extra time for processing.
  • Check frequently to assess if the child is processing information.
  • Link new information to prior knowledge.
  • Identify the purpose of reading.
  • Read a portion of text and then review what has happened before reading the next section. Encourage note taking.
  • Practice motor skills, craft activities, cutting with scissors, drama and musical games, work with stencils and templates.
  • Build on things the child likes and can do.
  • Encourage a special hobby or lessons to acquire a special skill.
  • Discuss seizures and epilepsy openly with the child and answer his or her questions about it.
  • Encourage the child to be active and have as much social contact with other children as possible.
  • Try not to make the child’s seizures a reason not to do things that the family would otherwise do.

Please CLICK HERE to download the fact sheet.

References:

Alarcon, G., Nashef, L., Cross, H., Nightingale, J., Richardson, S., (2009). Epilepsy. Oxford: Oxford University Press

Browne, T., Holmes, G. (2008). Handbook of Epilepsy. Philadelphia: Lippincott Williams & Wilkins

Little, A (2002) Epilepsy- A Resource for Teachers. Brisbane: Epilepsy Queensland.

www.epilepsyresearch.org.uk

www.epilepsyfoundation.org

Information reviewed by Dr. Dan McLaughlin, Brisbane and updated February 2014. To be reviewed 2016.