What is temporal lobe epilepsy?
Temporal lobe epilepsy is the most common form of symptomatic localized epilepsy (60–65%).
Causes of Temporal Lobe Epilepsy
The causes of temporal lobe epilepsy are perinatal trauma and hypoxemia, post-traumatic focal gliosis of the temporal pole, hippocampal sclerosis, post-encephalitic changes, trauma, ganglioglioma, minor gliomas, AVM, venous angiomas and scars after cerebral infarction, cerebral vessel, cerebral arteriosclerosis, AVM, venous angiomas and scars after cerebral infarction, cerebral arteries, AVM, venous angiomas and scars after cerebral infarction, cerebral arteries, AVM, venous angiomas and scars after cerebral infarction, cerebral vascular angiogram
Symptoms of Temporal lobe Epilepsy
Age of onset – any, but more often either in childhood or in the second decade of life.
Attacks of epilepsy of the temporal lobe: elemental-focal (olfactory, auditory, epigastric phenomena), complex partial, secondarily generalized. Complex partial often begin with stopping the movement with oro-alimentary automatisms. Duration more than a minute, indistinct ending, post-attack confusion, amnesia of an attack. Attacks are often serial.
When the hippocampal (mediobasal limbic or primary rhinencephalic psychomotor) form is 70–80% of temporal lobe epilepsy, seizures appear in groups or separately: they are complex focal, starting with strange indescribable sensations, hallucinations or illusions followed by disconnection (conspiracy of the view) rotator or food automatisms. 2 minutes last on average. With progression, generalized tonic-clonic convulsions may occur.
Amygdaloid epilepsy (front pole-amygdaloid) seizures accompanied with epigastric discomfort, nausea, severe vegetative symptoms and other manifestations (belching, pallor, swelling, redness of the face, dyspnea, dilated pupils, anxiety, panic, olfactory, gustatory hallucinations). Stupor, unconsciousness comes gradually, accompanied by a numb look, oral and food automatisms, external manifestations of “confusion.” Combination with generalized tonic-clonic convulsions with a focal beginning is rare (30%).
In case of lateral posterior epilepsy, seizures with aura in the form of auditory hallucinations, visual hallucinations with speech disorders in the case of localization of the lesion in the hemisphere, which is dominant for speech. Following this, dysphasia, disorientation of orientation or prolonged auditory hallucinations, head movements in one direction, sometimes automatization with sight stopping, occur. Often – dreamlike states (Dreamy State).
Opercular (insular) epilepsy is manifested by vestibular or auditory hallucinations, belching or vegetative manifestations, unilateral facial twitches and paresthesias. There are olfactory gustatory hallucinations.
Mind: often learning difficulties, memory impairment, perseveration tendency, egocentrism, thoroughness, accuracy, heightened sense of duty, conflict, emotional lability.
Neurology: depends on etiology, often scanty.
Diagnosis of temporal lobe epilepsy
It proceeds from etiological factors, clinical types of seizures, mental and neurological features, neuroradiological diagnostics, CT, NMR, angiography and EEG data. EEG between seizures shows typical front-temporal acute waves, especially when registering during sleep. For an EEG taken during a seizure, an initial one-sided flattening is typical, especially in the temporal leads. When SEEG recorded high-frequency (16-28 Hz) low-voltage peaks coming from the same hippocampus and extending into the amygdala and cingulate gyrus of the same hemisphere or mediobasal structures of the contralateral side. With seizures by the type of automatism, rhythmic primary or secondary generalized theta activity is possible without acute phenomena.
In diffiagnostics should be aware that temporal attacks can be mistaken for bouts of frontal epilepsy. The volume of special studies and the differential diagnosis – as with partial symptomatic epilepsy of the frontal lobe.
The course of epilepsy of the temporal lobe is characterized by unfavorable trends and more progressively with the predominance of early exogenous factors in etiology, the onset of the disease with frequent seizures, the presence of gross psychopathological disorders and changes in the EEG of the organic type. The prognostically favorable are the simplification of seizures, the transition from complex forms of partial seizures to simple ones, and with convulsive manifestations from developed to abortive. In 30-40% with the right therapy, you can stop the attacks, persistent drug remission.
Treatment of temporal lobe epilepsy
Drug treatment of symptomatic focal epilepsy is in most cases difficult. The means of first choice AK – Carbamazepine. The second choice is Valproate, Difenin, Hexamidine. Etiological (symptomatic) therapy. With ineffectiveness – surgical treatment.