Temporal Lobe Epilepsy (TLE)

Overview

• Temporal lobe epilepsy is the most common form of focal epilepsy.
• Involves one or both temporal lobes in the brain.
• Comprises about 60% of focal epilepsy cases.
• Two types: Mesial Temporal Lobe Epilepsy (MTLE) and Neocortical or Lateral Temporal Lobe Epilepsy.

Types

Mesial Temporal Lobe Epilepsy (MTLE)

• Involves medial/internal structures of the temporal lobe.
• Seizures often begin in the hippocampus or surrounding area.
• Accounts for 80% of temporal lobe seizures.
• Typically begins around ages 10-20 but can start at any age.

Neocortical or Lateral Temporal Lobe Epilepsy

• Involves the outer part of the temporal lobe.

Seizure Characteristics

• Focal Onset Seizures: Modern term for seizures formerly known as complex partial or simple partial.
• Focal Aware Seizures (Auras): Simple partial seizures, initial symptoms like déjà vu or stomach upset.
• Focal Impaired Awareness Seizures: Complex partial seizures, may include fixed stare, confusion, or lip-smacking.
• Generalized Tonic-Clonic Jerking: Can follow focal seizures, includes weakness post-seizure.

Risk Factors and Causes

• Brain injury, head trauma, birth injury, infections (encephalitis, meningitis).
• Structural changes in the temporal lobe, such as malformations or tumors.
• Prolonged or focal febrile seizures are significant risk factors.

Diagnosis

• Clinical diagnosis from symptom descriptions and witness observations.
• MRI: Look for temporal lobe changes, especially hippocampal sclerosis.
• EEG: May show spike or sharp waves in temporal lobe.

Treatment

Medications

• Anti-seizure drugs can control seizures for many but not all.

Surgery

• Considered if medication fails.
• Surgery often successful in cases with hippocampal sclerosis.

Devices

• Vagus nerve stimulation (VNS) or responsive neurostimulation (RNS) may help if surgery isn't an option.

Outlook

• 2 out of 3 people achieve good control with medication.
• Surgery can improve outcomes if medications are ineffective.
• Risks include memory issues, mood problems, and SUDEP if untreated.

Recommendations

• Consult epilepsy specialists and consider epilepsy centers for advanced evaluation and treatment.
• Early surgical evaluation improves chances of successful outcomes.