Do you also have a fit where you suddenly feel strange things and lose your memory? This is about Temporal Lobe Epilepsy (TLE)

Have you ever suddenly felt a very strange feeling in your heart for no reason? Like a feeling of déjà vu, or a strange feeling in your stomach. You may have been unaware of what was happening around you for a while. While many people think that these things are normal, sometimes they can be caused by a small change in the brain's function. Today we are going to talk about one such condition, namely Temporal Lobe Epilepsy (TLE).

Simply put, what is Temporal Lobe Epilepsy (TLE)?

Temporal Lobe Epilepsy (TLE) is a type of seizure (fit) caused by abnormal electrical activity in a part of our brain called the 'Temporal Lobe'. Okay, now you're probably wondering what this 'Temporal Lobe' is.

These two temporal lobes are located on either side of our brain, exactly behind the cheeks and slightly in front of the ears. This part is very important for our daily lives.

• Memories: This is what helps us remember and recall the things we learn, our old memories.
• Sounds: Help us understand what we hear.
• Vision: Helps us identify what we see.
• Speech and language: This section is essential for understanding what we say and what others say.

In addition to these things, it also controls many things that are not consciously controlled, such as hunger, thirst, the fight-or-flight response, our emotions, and sexual feelings.

So, TLE is a seizure that occurs in this important area. This is the most common type of seizure in adults, which starts in one specific area of ​​the brain (focal epilepsy). Don't worry, this condition can be managed well.

Does it matter whether you are on the left or right side of the brain?

Yes, the symptoms and long-term effects may differ slightly depending on whether the fit begins in the left temporal lobe or the right temporal lobe of the brain.

• Left Temporal Lobe Epilepsy: For many people, especially right-handed people, the left side is the dominant side of the brain involved in language and speech. So, people with left-sided TLE may experience problems over time, such as difficulty remembering names of things, difficulty finding the right words to say, and changes in emotions.
• Right Temporal Lobe Epilepsy: People with right temporal lobe epilepsy do not have much trouble with language. However, they may have difficulty remembering non-verbal cues (such as faces and roads). They may also experience changes in their emotions.

Are there types of TLE?

Yes, there are two main types of TLE, depending on the exact location where the fit begins.

1. Mesial Temporal Lobe Epilepsy (MTLE): "Mesial" means "middle." In this type of epilepsy, the seizure begins in or near the hippocampus, a structure located deep within the temporal lobe. The hippocampus is like a small library where our memories are stored. The majority of people with TLE have this type of MTLE.

2. Neocortical (or Lateral) Temporal Lobe Epilepsy: In this case, the fit begins in the outer part of the temporal lobe.

What are the symptoms of TLE? How is it diagnosed?

The symptoms of TLE can be divided into two parts. One is the pre-seizure symptoms that occur before the seizure. We also call this the 'aura'. The other part is the symptoms that occur during the seizure.

Let's look at these features in a little more detail.

Why does this TLE occur? What are the causes?

Simply put, TLE occurs when the communication between nerve cells (neurons) in the temporal lobe is disrupted. Normally, these nerve cells send electrical signals in an orderly manner to keep our brains working. When a fit occurs, these nerve cells fire continuously without control.

There are several main reasons that can affect this:

• Hippocampal sclerosis: This is the main cause of TLE. It occurs when nerve cells in the area of ​​the brain called the hippocampus, which is involved in memory, become damaged and scarred.
• Brain tumors: Cancerous or benign tumors can disrupt brain function.
• Traumatic brain injury: Damage to the head from a severe accident.
• Infections: Infections such as encephalitis and meningitis.
• Problems at birth: Certain abnormalities that occur during brain development (Focal cortical dysplasia).
• Blood vessel problems: Conditions like strokes.
• Genetic variants: Certain genetic influences that are passed down through generations.
• Unidentified causes: Sometimes, a specific cause may not be found.

Who is at higher risk of developing this condition?

TLE can occur at any age, but certain factors may increase the risk.

• If you have had a febrile seizure as a child: Especially if you have had a lot of seizures. But remember, not everyone who has had a febrile seizure will develop TLE. It is very rare.
• If you have status epilepticus: This means that the seizure lasts more than 5 minutes, or that the seizure occurs repeatedly before you regain consciousness.
• If you have a brain tumor or birth defect.
• If you had a head injury or brain infection as a child.
• If someone in the family has TLE.

What are the complications if left untreated?

If TLE is left untreated for a long time, certain complications can occur. This risk increases over time as the frequency of the fits increases.

The main complications are:

• Memory loss: Difficulty remembering things, especially new ones.
• Depression and Anxiety: Living with this condition can cause some mental stress.
• Decreased ability to learn and make decisions.
• SUDEP (Sudden unexplained death in epilepsy): This is a very rare, but very serious complication. In this, a person with epilepsy dies suddenly and for no apparent reason. The best way to reduce this risk is to control the seizure well.

How does a doctor diagnose this? (Diagnosis)

If you have had a fit or suspect you have had one, you should definitely see a doctor. He or she will ask you questions, examine you, and, if necessary, run some tests to make a diagnosis.

• Asking about your symptoms: The doctor will ask about what happened before, during, and after the fit.
• Witness statement: Since you may lose consciousness during the seizure, it is very important to bring someone who was with you at the time (family member, friend) with you to the doctor. They can describe exactly what they saw.
• Neurological examination: This tests the function of your brain and nervous system.

In addition, you can also do tests like these:

• MRI (Magnetic Resonance Imaging): Takes clear images of the brain to see if there are any abnormalities (such as a tumor or scar).
• EEG (Electroencephalogram): Small sensors are placed on the head and record the electrical activity of the brain. If this is done at the time of the seizure, it can pinpoint where in the brain the seizure is starting. You may be kept in the hospital for a day or more to have a Video-EEG test.

What are the treatments for TLE?

There are several effective treatments for TLE. Your doctor will determine the best treatment for you based on your condition.

1. Antiseizure medications

This is the first line of treatment. There are many medications that can control TLE. (e.g. Carbamazepine, Levetiracetam, Valproate).

During pregnancy: If you are planning to become pregnant or are already pregnant, it is very important to tell your doctor. Some medications can affect the baby. Your doctor will prescribe a safer medication for you at that time.

2. Surgery (Epilepsy surgery)

If the fit cannot be controlled with medication, or if there is a cause that can be removed, such as a brain tumor, the doctor may recommend surgery.

• Temporal lobectomy: This involves removing a small part of the temporal lobe of the brain where the seizures begin. Neurosurgeons do this very carefully, taking care not to damage other brain functions. Many people have been able to stop their seizures almost completely after this surgery.

3. Neurostimulation

This method is used when medications don't work and surgery isn't possible. This involves sending electrical signals to the brain through a small device implanted in the body, gradually reducing the frequency of seizures over time. It's like putting a pacemaker in the heart.

When should you see a doctor?

If you have or suspect you are having a seizure, be sure to see a doctor. If you are already being treated for TLE, you should call your doctor immediately if:

• If the fit lasts more than 5 minutes. (This is an emergency and you should be taken to a hospital's Emergency Department (ETU) immediately.)
• If one fit is over and another one comes before you regain consciousness.
• If the frequency and severity of the fit suddenly increase.
• If new side effects occur from the medication.
• If it takes longer than usual to recover after a fit.

Temporal Lobe Epilepsy is a manageable condition. Living with it can be challenging at times. But with the right treatment and lifestyle changes, you can live a normal life. You are not alone, and your doctor and family are there to help you.