Temporal Epilepsy: Symptoms, Treatment, Prognosis

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Temporal lobe epilepsy

The content of the article:

1. Causes and risk factors
2. Forms of the disease
3. Symptoms
4. Diagnostics
5. Treatment
6. Possible complications and consequences
7. Forecast
8. Prevention

Temporal epilepsy is one of the forms of epilepsy in which an epileptogenic focus is located in the temporal lobe of the brain.

The disease in most cases occurs in patients under 20 years of age. In about 30% of cases, it develops in children during the first three years of life.

The incidence rate of temporal lobe epilepsy is quite high: from 5 to 10 cases per 1000 people.

An epileptogenic focus in temporal lobe epilepsy is located in the temporal lobe of the brain

Causes and risk factors

Various factors can lead to the development of temporal lobe epilepsy. In about 35% of cases, the causes of the disease are perinatal, that is, arising during the period of intrauterine development of the fetus or childbirth, lesions of the central nervous system:

• intrauterine infection (syphilis, cytomegalovirus, rubella, measles);
• intrauterine fetal hypoxia;
• asphyxia of the newborn;
• birth trauma;
• focal cortical insufficiency.

In other cases, the factors that provoke the development of temporal lobe epilepsy may be:

• ischemic or hemorrhagic stroke;
• cerebral aneurysm;
• intracerebral hematoma;
• tuberous sclerosis;
• brain abscess;
• brain tumors (glioma, astrocytoma, angioma);
• traumatic brain injury.

Traumatic brain injury can lead to temporal lobe epilepsy

Very often, temporal lobe epilepsy develops as a result of neuroinfections:

• post-vaccination encephalomyelitis;
• Japanese mosquito encephalitis;
• purulent meningitis;
• tick-borne encephalitis;
• neurosyphilis;
• herpes infection;
• brucellosis.

Often, the temporal form of epilepsy occurs against the background of mesial (medial) temporal sclerosis. However, experts cannot yet answer unequivocally what this pathology is (the cause of the disease or its consequence).

Forms of the disease

Depending on the exact location of the epileptogenic focus in the temporal lobe of the brain, temporal lobe epilepsy is divided into several forms:

• insular (opercular);
• lateral;
• hippocampal;
• amygdala.

However, for greater convenience, clinicians divide temporal lobe epilepsy into only two groups:

• amygdala-hippocampal (mediobasal);
• lateral.

Bilateral (bitemporal) temporal lobe epilepsy is also distinguished as a separate form. The presence of two foci of epileptic activity can be associated either with the simultaneous damage to both temporal regions of the brain, or with the formation of a second, "mirror" focus as the disease develops.

Symptoms

Temporal epilepsy, combined with temporal lobe medial sclerosis, usually debuts in childhood from 6 months to 6 years with the onset of an episode of febrile, that is, occurring against a background of high temperature, atypical seizures. After this, spontaneous remission occurs, lasting 3-5 years. At the end of remission, the patient develops afebrile psychomotor convulsions.

With temporal lobe epilepsy, complex partial (SPP), simple and secondary generalized (IGP) seizures can occur. According to statistics, in about 50% of cases of temporal lobe epilepsy, seizures are mixed.

Temporal lobe epilepsy often debuts in childhood

A distinctive feature of simple seizures is the preservation of consciousness. Such seizures often occur in the form of an aura or precede the development of AIV or SPP. Simple motor seizures are manifested by a fixed position of the hand or foot, turning the eyes or head towards the location of the focus of convulsive readiness. Simple sensory seizures proceed as attacks of systemic dizziness, visual or auditory hallucinations, and disturbances in the perception of smell and taste.

Temporal epilepsy can also occur with attacks of vestibular ataxia, often combined with impairments in the correct perception of space. Sometimes the disease is accompanied by respiratory, epigastric and cardiac somatosensory paroxysms, which has the following manifestations:

• feeling short of breath;
• feeling of a lump in the throat;
• heartburn;
• nausea;
• abdominal pain;
• pressing or bursting pain in the region of the heart;
• heart rhythm disturbances;
• pallor of the skin;
• hyperhidrosis;
• feeling of fear.

For mediobasal temporal lobe epilepsy, simple seizures with symptoms of depersonalization and derealization are most characteristic.

With complex partial seizures, the patient loses consciousness and stops responding to external stimuli. These seizures in the temporal form of epilepsy can proceed with a slow fall without seizures, without stopping and with a stop of motor activity (the patient suddenly freezes in place). Often, complex partial seizures are combined with repetitive movements (automatisms): smacking, stomping on the spot, hissing, chewing, etc.

With the progression of temporal lobe epilepsy, patients develop secondary generalized seizures occurring with a clonic-tonic seizure and loss of consciousness.

Convulsions with progression of temporal lobe epilepsy

Over time, temporal lobe epilepsy leads to various intellectual-mnestic and emotional-personality disorders:

• slowness;
• forgetfulness;
• excessive thoroughness, viscosity of thinking;
• emotional instability, conflict, aggressiveness;
• impaired ability to communicate.

Often, temporal lobe epilepsy is accompanied by neuroendocrine disorders:

• polycystic ovaries and menstrual irregularities in women;
• hyperprolactinemic hypogonadism;
• hypothyroidism;
• osteoporosis;
• decreased libido;
• infertility.

Diagnostics

Diagnosing temporal lobe epilepsy can be challenging. In adults, detection of the disease usually occurs at the stage of the onset of secondary generalized seizures. This is due to the fact that most patients do not notice simple and complex partial seizures or do not consider them a reason for seeking medical help.

In children, temporal lobe epilepsy is usually diagnosed early. Parents bring the child for counseling, being concerned about the appearance of automatic movements, behavioral disturbances or periodic blackouts.

MRI and PET can help determine the cause of temporal lobe epilepsy

Neurological disorders in temporal lobe epilepsy are usually not observed, unless the disease develops against the background of a hematoma, stroke, or brain tumor.

Electroencephalography in temporal lobe epilepsy in most cases does not reveal any changes. Therefore, to diagnose the disease and detect a focus of epileptic activity, it is recommended to carry out polysomnography with recording an electroencephalogram during the patient's sleep.

To establish the cause of temporal lobe epilepsy, MRI and PET are performed.

Treatment

Therapy for temporal lobe epilepsy is aimed at achieving remission of the disease, that is, a complete cessation of seizures. It usually starts with carbamazepine. If it is ineffective, a drug from the group of benzodiazepines, barbiturates, hydantoins, valproates is prescribed. If monotherapy for temporal lobe epilepsy does not lead to a lasting positive result, various combinations of antiepileptic drugs are used.

For temporal lobe epilepsy, carbamazepine is usually given

In case of a form of temporal lobe epilepsy resistant to drug therapy, surgical treatment is recommended.

Possible complications and consequences

The main complications of epilepsy are:

1. Status epilepticus. Convulsive seizures occur after very short periods of time, so short that in the interval between them the patient's consciousness is not restored. This condition requires urgent medical attention, as it can cause serious respiratory and cardiac dysfunction, up to and including death.
2. Aspiration pneumonia. During a convulsive attack, vomit and food particles can enter the airways, which cause the inflammatory process.
3. Injuries. Sudden falls of patients during an attack can lead to soft tissue bruises, bone fractures, head injuries.
4. Mental disorders.

Medical and surgical treatment of temporal lobe epilepsy can also be associated with complications. For example, 25% of patients receiving antiepileptic drugs develop allergic, metabolic, or toxic side effects.

Surgical treatment of epilepsy can cause impaired reading (alexia), speech, memory and intelligence, hemiparesis.

Forecast

Medical treatment of temporal lobe epilepsy leads to remission in 30–35% of cases. In most patients, it only reduces the frequency of attacks.

Surgical treatment of temporal lobe epilepsy in 30–45% of cases completely relieves the patient of the manifestations of the disease, in other patients the frequency of seizures is significantly reduced.

Prevention

Prevention of temporal lobe forms of epilepsy is divided into primary and secondary. The primary one is aimed at eliminating the causes that can cause the disease:

• careful monitoring of the condition of the pregnant woman and the fetus;
• timely treatment of intrauterine fetal hypoxia;
• rational management of childbirth;
• treatment of intrauterine infections and neuroinfections.

Secondary prevention concerns patients already suffering from temporal lobe epilepsy and aims to prevent seizures from occurring. It consists in careful adherence to the antiepileptic drug regimen, adherence to the bottom regimen, balanced nutrition, exercise therapy and elimination of specific pathogens that increase the seizure activity of the brain (for example, loud music).

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Elena Minkina Doctor anesthesiologist-resuscitator About the author

Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.

Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!