Temporal lobe epilepsy (TLE) is the most frequent form of drug-resistant focal epilepsy, and is characterized by seizures that arise from the temporal lobe(s). Policy. , The causes of TLE include mesial temporal sclerosis, traumatic brain injury, brain infections, such as encephalitis and meningitis, hypoxic brain injury, stroke, cerebral tumours, and genetic syndromes. In animal models, neuronal loss occurs during seizures but in humans, neuronal loss predates the first seizure and does not necessarily continue with seizure activity. Most anticonvulsants function by decreasing the excitation of neurons, for example, by blocking fast or slow sodium channels or by modulating calcium channels; or by enhancing the inhibition of neurons, for example by potentiating the effects of inhibitory neurotransmitters like GABA. They project into the hilus of the dentate gyrus and stratum lucidum in the CA3 region giving inputs to both excitatory and inhibitory neurons. Last reviewed by a Cleveland Clinic medical professional on 09/17/2018. Focal aware means that the level of consciousness is not altered during the seizure. The person cannot interact with the surrounding environment as they normally could. Temporal lobe epilepsy may, for example, cause sudden outbursts of unexpected aggression or agitation, or it may be characterized by aura-like phenomena. In J. Engel Jr. & T.A. , Where surgery is not recommended, further management options include new (including experimental) anticonvulsants, and vagus nerve stimulation. About 3 million adults and 470,000 children and adolescents have been diagnosed with epilepsy in the United States, according to the Centers for Disease Control. Temporal lobe epilepsy (TLE) is seizure activity affecting the temporal lobe of the brain. This part of the brain controls memory, emotions, and language processing. The newer classification gives two types of focal onset seizures, as focal aware and focal impaired awareness..  However, as of 2017 the general classification of seizures has been revised. Temporal lobe epilepsy can result from several different disorders, including temporal tumors, brain injuries, severe infections, and strokes. This study was presented as an abstract at a neuroscience conference and referenced in Ramachandran's book, Phantoms in the Brain, but it has never been published in the peer-reviewed scientific press. The temporal lobes are the areas of the brain that most commonly give rise to seizures. Temporal lobe, or psychomotor, seizures are caused by abnormal electrical activity in an area of the brain known as the temporal lobe, which sits just above your ear. Treatments of temporal lobe seizures includes medications, diet, surgery, laser, and electrical brain stimulator devices. Overview. The aura is actually considered a seizure itself – it is a focal aware seizure – that, in this case, has progressed to a focal impaired awareness seizure. Dysphoric or euphoric feelings, fear, anger, and other emotions may also occur. These seizures tend to have an aura before they occur. The temporal lobes are on the sides of the brain behind the temples. Simple means you stay aware of your surroundings. , Temporal lobe surgery can be complicated by decreased cognitive function. The most common surgery for epilepsy is a temporal lobectomy, which is the removal of a portion of the temporal lobe. Some people remain aware of what's happening, but during more-intense se…  This structure provides a filter for the excitability of neurons. Temporal lobe or psychomotor seizures are caused by abnormal electrical activity in one area of the brain. During a seizure, a person can experience a change in behavior, body movements, and level of awareness (consciousness). Felbamate and vigabatrin are newer, but can have serious adverse effects so they are not considered as first-line treatments. It may be simple or complex. Vilayanur S. Ramachandran explored the neural basis of the hyperreligiosity seen in TLE using the galvanic skin response (GSR), which correlates with emotional arousal, to determine whether the hyperreligiosity seen in TLE was due to an overall heightened emotional state or was specific to religious stimuli. Some symptoms of a temporal lobe seizure may be related to these functions, including having odd feelings — such as euphoria, deja vu or fear. Defining temporal lobe epilepsy is simple because the seizure attack begins in the temporal lobe of the brain. The first line of treatment is through anticonvulsants. (p416–431), Aberrant mossy fibre sprouting may create excitatory feedback circuits that lead to temporal lobe seizures. The good news about temporal lobe resection surgery for epilepsy is that the risks, side effects, and potential complications are extremely low, and … This is the postictal state. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. It has been shown that it is theoretically possible to generate seizures in the neural networks due to down-regulation of KCC2, consistent with the chloride measurements during the transition to seizure and KCC2 blockade experiments. Lifestyle Changes Follow your biological clock. Focal aware seizures are often called "auras" when they serve as a warning sign of a subsequent seizure. Hyperreligiosity.  In temporal lobe epilepsy, a focal seizure usually causes abnormal sensations only. The first to record and catalog the abnormal symptoms and signs of TLE was Norman Geschwind. TLE is the most common form of epilepsy with focal seizures. (p387–389), Mossy fibers are the axons of granule cells. Everyone has a biological or internal clock that … CORONAVIRUS: DELAYS FOR ROUTINE SURGERIES, VISITOR RESTRICTIONS + COVID-19 TESTING. (1998) Personality disorders. In practice, however, many of these patients will undergo standard anterior temporal lobectomy. The temporal lobe is the area of the brain that processes memories and sounds, interprets vision, produces speech, understands language, controls some unconscious/automatic responses such as hunger, thirst, fight-or-flight, emotions, and sexual arousal. Ramachandran was able to show that patients with TLE showed enhanced emotional responses to the religious words, diminished responses to the sexually charged words, and normal responses to the neutral words. Some individuals may exhibit hyperreligiosity, characterized by increased, usually intense, religious feelings and philosophical interests, and partial ( temporal lobe) epilepsy patients experiencing frequent auras, perceived as numinous in character, exhibit … In TLE, the most commonly used older medications are phenytoin, carbamazepine, primidone, valproate, and phenobarbital.  The word grand mal comes from the French term, meaning major affliction. Epilepsy is a brain disorder that causes changes in brain cell activity that result in seizures, periods of unusual behavior or feelings, and in some cases a loss of consciousness. , In TLE, there is loss of neurons in region CA1 and CA3 of the hippocampus. , TLE has been suggested as a materialistic explanation for the revelatory experiences of prominent religious figures such as Abraham, Moses, Jesus, Mohammed, Saint Paul, Joan of ArcSaint Teresa of Ávila and Joseph Smith. Regardless, an aura is actually a seizure itself, and such a focal seizure may or may not progress to a focal impaired awareness seizure. A focal seizure is just a surge of electrical activity in one part of the brain, as opposed to a generalized seizure which affects multiple areas. Also, in animal models, granule cell hyper-excitability is recorded before aberrant mossy fibre sprouting has occurred.. Olfactory hallucinations often seem indescribable to patients beyond "pleasant" or "unpleasant".. These early feeling does not necessarily occur in all the patient suffering from temporal lobe epilepsy. . However, numerous other brain regions play a pivotal role in seizure circuitry and secondary generalization of epileptic activity: The substantia nigra pars reticulata (SNr) and its direct input structure, the subthalamic nucleus (STN), are considered seizure gating nuclei. The condition causes uncontrolled electrical activity in … Automatisms are common during the seizure, and include oral and/or manual automatisms. Nerve cell death, which results in scarring in the temporal lobe (called mesial temporal sclerosis or …  The personality changes generally vary by hemisphere. It is not uncommon for an individual to be tired or confused for up to 15 minutes after a seizure has occurred, although postictal confusion can last for hours or even days. They usually begin with a focal aware seizure, then spread to a larger portion of the temporal lobe, resulting in impaired consciousness. Advertising on our site helps support our mission. This approach has been used to identify cognitive phenotypes in temporal lobe epilepsy (TLE). Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality. One type, called focal-to-bilateral seizures, begin in the temporal lobe and then spreads to involve both sides of the brain. This abnormal electrical activity results in events called seizures. Learn about the symptoms. The temporal lobe is responsible for the emotion process and the short-term memory. , Individuals with temporal lobe epilepsy have a higher prevalence of depression than the general population. Temporal lobe in green, A sudden sense of unprovoked fear and anxiety, Auditory, visual, olfactory, gustatory, or tactile. These seizures tend to have a warning or aura before they occur, and when they occur they generally tend to last only 1–2 minutes. Epilepsia 2017 Apr;58(4):522-530.  Pope Pius IX's doctrine of the immaculate conception is thought to have been influenced by his forensically-diagnosed partial epilepsy. Declarative memory (memories which can be consciously recalled) is formed in the area of the hippocampus called the dentate gyrus. Temporal lobe epilepsy is a condition in which patients have seizures from uncontrolled electrical activity in the temporal lobe. & Hermann, B.P. Where both sides of the brain or the whole brain are involved from the onset, these seizures are known as generalized seizures and may be tonic clonic. For instance, if the dendrites of granule cells reconnect, it may be in a way (through the laminar planes) that allows hyperexcitability. Temporal Lobe Epilepsy. The laser is directed at scar tissue in the temporal lobe region that is … There are many types of epilepsies and more than 30 types of seizures. Ramachandran presented two subjects with neutral, sexually arousing and religious words while measuring GSR. Seizures which begin in the temporal lobe, and then spread to involve both sides of the brain are termed focal to bilateral. Newer drugs, such as gabapentin, topiramate, levetiracetam, lamotrigine, pregabalin, tiagabine, lacosamide, and zonisamide promise similar effectiveness, with possibly fewer side-effects. Though they may not seem harmful, due to the fact that the individual does not normally seize, they can be extremely harmful if the individual is left alone around dangerous objects.  The granule cells of the dentate gyrus are tightly packed forming a uniform, laminated layer with no monosynaptic connections. ), "2017 Revised Classification of Seizures", "Synesthetic associations and psychosensory symptoms of temporal epilepsy", "Cortical thickness abnormalities associated with depressive symptoms in temporal lobe epilepsy", "Association of Human Herpesvirus-6B with Mesial Temporal Lobe Epilepsy", "Detection of human herpesvirus-6 in mesial temporal lobe epilepsy surgical brain resections", "Role for reelin in the development of granule cell dispersion in temporal lobe epilepsy", "Reelin deficiency and displacement of mature neurons, but not neurogenesis, underlie the formation of granule cell dispersion in the epileptic hippocampus", "Reduced inhibition of dentate granule cells in a model of temporal lobe epilepsy", "Quantitative post-mortem study of the hippocampus in chronic epilepsy: seizures do not inevitably cause neuronal loss", "GABAergic mechanisms in the pathogenesis and treatment of epilepsy", "Perturbed Chloride Homeostasis and GABAergic Signaling in Human Temporal Lobe Epilepsy", "Reduced Efficacy of the KCC2 Cotransporter Promotes Epileptic Oscillations in a Subiculum Network Model", "Pyramidal cells accumulate chloride at seizure onset", "Selective Inhibition of KCC2 Leads to Hyperexcitability and Epileptiform Discharges in Hippocampal Slices and In Vivo", "Cell proliferation and granule cell dispersion in human hippocampal sclerosis", 10.1002/(sici)1096-9861(19970901)385:3<325::aid-cne1>3.0.co;2-5, "Axon sprouting in a model of temporal lobe epilepsy creates a predominantly excitatory feedback circuit", "Evidence of functional mossy fiber sprouting in hippocampal formation of kainic acid-treated rats", "Kainic acid-induced recurrent mossy fiber innervation of dentate gyrus inhibitory interneurons: possible anatomical substrate of granule cell hyperinhibition in chronically epileptic rats", "Spontaneous release of neuropeptide Y tonically inhibits recurrent mossy fiber synaptic transmission in epileptic brain", "Temporal Lobe Epilepsy Workup: Approach Considerations, Computed Tomography Scanning, Magnetic Resonance Imaging", "Temporal Lobe Epilepsy; TLE medical Information Page | Patient", "Changing frontal contributions to memory before and after medial temporal lobectomy", "MR-guided stereotactic laser ablation of epileptogenic foci in children", "Spirituality aspects in patients with epilepsy", "The role of psychotic disorders in religious history considered", "Seizures among public figures: lessons learned from the epilepsy of Pope Pius IX", Reproductive endocrinology and infertility, Bachelor of Medicine, Bachelor of Surgery, https://en.wikipedia.org/w/index.php?title=Temporal_lobe_epilepsy&oldid=991880079, Short description is different from Wikidata, Articles with unsourced statements from September 2016, Articles with unsourced statements from February 2014, Articles needing additional medical references from August 2017, All articles needing additional references, Articles requiring reliable medical sources, Creative Commons Attribution-ShareAlike License, Lobes of the brain.  These changes may or may not be epileptogenic. The site of this seizure is a localized area but then spreads to other areas of the temporal lobe, causing the impaired awareness. Cleveland Clinic is a non-profit academic medical center. First-aid is only required if there has been an injury or if this is the first time a person has had a seizure. Temporal lobe epilepsy is the most common type of epilepsy, in which the seizures originate in the temporal lobe of the brain. The seizure may last 60 to 90 seconds. However, it was not until 2001 that a scientifically sound study was carried out to examine the effectiveness of temporal lobectomy.  Other options include brain cortex responsive neural stimulators, deep brain stimulation, stereotactic radiosurgery, such as the gamma knife, and laser ablation.. Temporal lobe epilepsy (TLE) is a chronic disorder of the nervous system characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. , The effect of temporal lobe epilepsy on personality is a historical observation dating to the 1800s. We do not endorse non-Cleveland Clinic products or services. Focal seizures in the temporal lobe involve small areas of the lobe such as the amygdala and hippocampus.  The arms, trunk, and legs stiffen (the tonic phase), in either a flexed or extended position, and then jerk (the clonic phase). , Granule cell dispersion is a type of developmental migration and a pathological change found in the TLE brain which was first described in 1990. , In the TLE brain, where granule cells are damaged or lost, axons, the mossy fibres, 'sprout' in order to reconnect to other granule cell dendrites. For patients with medial TLE whose seizures remain uncontrolled after trials of several types of anticonvulsants (that is, the epilepsy is intractable), surgical excision of the affected temporal lobe may be considered. An aura is a “warning sign” that happens before this type of seizure occurs. Rhythmic slow activity (around 4 to 7 Hz) that appears over the affected temporal lobe, before or simultaneously with clinical events. , In 2016, a case history found that a male temporal lobe epileptic patient experienced a vision of God following a temporal lobe seizure, while undergoing EEG monitoring. Blood tests.Your doctor may take a blood sample to check for signs of infections, genetic conditions, blood su… In 1981, the ILAE recognized three types of seizures occurring in temporal lobe epilepsy. Most of the time people do not remember experiencing any aura. Personality and behavioural change in temporal lobe epilepsy is seen as a chronic condition when it persists for more than three months. Temporal lobe … There are two types of focal seizures, each of which has its own distinct signs and symptoms, as follows: Focal aware seizures (previously called simple partial seizures without loss of awareness) means that the level of consciousness does not change during the seizure; abnormal sensations may be all that occurs. (ed.  The postictal state in seizures other than focal aware may last much longer than the seizure itself. These seizures last from 30 seconds to 2 minutes. Temporal lobe epilepsy is the term for recurring seizures beginning in the temporal lobe – the section of the brain located on the sides of the head behind the temples and cheekbones. Unknown causes (accounts for about 25 percent of temporal lobe seizures), Nerve cell death, which results in scarring in the temporal lobe (called mesial temporal sclerosis or hippocampal sclerosis), Genetic factors (family history) or genetic mutations, Déjà vu (a feeling of familiarity), a memory, or jamais vu (a feeling of unfamiliarity), Sudden sense of fear or anxiety, anger, sadness, joy, A rising sick feeling in the stomach (the feeling you get in your gut riding a roller coaster), Altered sense of hearing, sight, smell, taste, or touch, Visual distortions (objects are larger or smaller than they actually are), Difficulty speaking or inability to speak, Repetitive behaviors and movements (called automatisms) of the hands (such as fidgeting, picking motions), eyes (excessive blinking), and mouth (lip smacking, chewing, swallowing), Unusual speech; altered ability to respond to others, Brief loss of ability to speak, read, or comprehend the spoken word. Often, the patient cannot describe the sensations. There is some period of recovery in which neurological function is altered after each of these seizure types. Temporal lobe epilepsy (TLE) is a disorder of the nervous system due to unprovoked seizures originating from the temporal lobe. Other medical conditions with similar symptoms include panic attacks, psychosis spectrum disorders, tardive dyskinesia, and occipital lobe epilepsy. Policy, Cleveland Clinic is a non-profit academic medical center. Additionally, it is possible for the attack to happen on both the temporal lobes. , The existence of a "temporal lobe epileptic personality" and Geschwind syndrome has been disputed and research is inconclusive. This is an example of synaptic reorganization. Advertising on our site helps support our mission. Temporal lobe encephaloceles (TEs) are increasingly identified in patients with epilepsy due to advances in neuroimaging. Auras are variable in symptomatology, and include: 1. viscerosensory aura 1.1. typically from l… The most common pathological abnormality in TLE is the mesiotemporal sclerosis, which is visible on conventional MRI. The degree and length of postictal impairment directly correlates with the severity of the seizure type. The main cause of TLE is neuronal hyperexcitability due to the presence of pathological changes in the temporal lobe of the brain such as neuronal loss, mutation, granule cell dispersion and malformations of cortical development. The most researched brain region in epilepsy research is the temporal lobe, and more specifically, the hippocampus. 1,2 Unfortunately, people with TLE also often experience disabling cognitive and memory impairments.  The loss of the GABA-mediated inhibitory interneurons may increase the hyperexcitability of neurons of the hippocampus leading to recurrent seizures. In 1/3 of mesial TLE cases, no appreciable changes occur. After a seizure, your doctor will thoroughly review your symptoms and medical history.  The purported link between TLE and religiosity has inspired work by Michael Persinger and other researchers in the field of neurotheology. Mossy fibre sprouting continues from one week to two months after injury. The classification was based on EEG findings. There may sensory (auditory), emotional (fear), cognitive (deja vu) or autonomic features (epigastric sensation, tachycardia, colour change) prior to onset of impaired awareness. Documented by Norman Geschwind, signs include: hypergraphia (compulsion to write (or draw) excessively), hyperreligiosity (intense religious or philosophical experiences or interests), hyposexuality (reduced sexual interest or drive), circumstantiality (result of a non-linear thought pattern, talks at length about irrelevant and trivial details). Temporal lobe seizures are characterized by behavioral arrest and impaired awareness . Cluster analysis revealed 3- and 4-cluster solutions, with clusters differentiated primarily by overall level of … Temporal Lobe Epilepsy. Automatic movements of the hands or mouth, Altered ability to respond to others, unusual speech, This page was last edited on 2 December 2020, at 08:02. This is more so on the left in verbal memory loss. , The International League Against Epilepsy (ILAE) recognizes two main types of temporal lobe epilepsy: mesial temporal lobe epilepsy (MTLE), arising in the hippocampus, the parahippocampal gyrus and the amygdala which are located in the inner (medial) aspect of the temporal lobe and lateral temporal lobe epilepsy (LTLE), the rarer type, arising in the neocortex at the outer (lateral) surface of the temporal lobe. If seizure activity spreads to affect the entire brain, it causes a loss … Anyone can develop epilepsy. Herein we report on the fir … It is unknown whether changes in reelin expression play a role in epilepsy. Centers for Disease Control and Prevention.  According to the "dormant basket cell" hypothesis, mossy cells normally excite basket cells which in turn, inhibit granule cells. , However, aberrant mossy fiber sprouting may inhibit excitatory transmission by synapsing with basket cells which are inhibitory neurons and by releasing GABA and neuropeptide Y which are inhibitory neurotransmitters.  A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure.  Lower education level, abnormal background EEG activity, and hippocampal sclerosis have been found to be contributing factors for religiosity in TLE. Psychiatric conditions with psychotic spectrum symptoms might be more plausible physical explanation of these experiences. , In certain patients with temporal lobe epilepsy it has been found that the subiculum could generate epileptic activity. Select patients become seizure-free with lesionectomy. Patients with temporal lobe epilepsy demonstrate three phases, each of variable duration and symptomatology: 1. preictal (aura) phase 2. ictal phase 3. postictal phase A variable number of patients with temporal lobe epilepsy demonstrate or describe an aura, which is usually of short duration, and in most cases (70%) goes on to become a seizure 2. Others have questioned the evidence for a link between temporal lobe epilepsy and religiosity. , Geschwind syndrome is a set of behavioural phenomena seen in some people with TLE. However, although the virus is found in temporal lobe tissue at surgery for TLE, it has not been recognised as a major factor in febrile seizures or TLE.