Temporal Lobe Epilepsy? - Let's talk about this simply!

Do you sometimes suddenly feel strange? Imagine, the place you are in feels familiar, but it's a new place. Or do you feel like something is rising from inside your stomach, or do you suddenly feel scared or anxious? Maybe you lose consciousness and have a state of convulsions with these things. If these things have happened to you or someone you know, it is very important to know about the condition we are going to talk about today called `Temporal Lobe Epilepsy`.

What is Temporal Lobe Epilepsy?

Simply put, Temporal Lobe Epilepsy is a type of epilepsy. In this case, the seizure begins in a part of your brain called the temporal lobe. A seizure is when there is an abnormality in the electrical activity inside the brain. Think of it like a short circuit in an electrical circuit.

We all have two 'temporal lobes' on either side of our brains, from the front of our ears to the back. This 'temporal lobe' is what helps us understand the world around us. It is:

• Keep the memories.
• Recognize sounds
• For things related to vision
• Understand the language and the conversation

In addition to this, some things that we do unconsciously, such as hunger, thirst, what we do when we are suddenly scared (fight-or-flight response), our emotions, and sexual desires, are also controlled by this 'temporal lobe'.

Temporal lobe epilepsy is the most common type of focal epilepsy, which starts in one specific area of ​​the brain. The main symptom is seizures. A doctor can help you manage this condition.

What is the difference between left and right temporal lobe epilepsy?

Both the left and right temporal lobes of your brain control many things, including memory, hearing, vision, and speech. However, these functions can be affected depending on which side the seizure starts.

For many people, especially if you are right-handed, the left temporal lobe is dominant. People with left temporal lobe epilepsy may experience difficulty naming objects, difficulty finding the right words, and mood changes over time.

People with right temporal lobe epilepsy generally have fewer long-term changes in memory. However, they may also experience difficulty remembering nonverbal information, especially images, and changes in mood.

Are there types of temporal lobe epilepsy?

Yes, there are two main types of `temporal lobe epilepsy`:

1. Mesial Temporal Lobe Epilepsy (MTLE): "Mesial" means middle. In this type of epilepsy, the seizures begin in or near a part of the brain called the hippocampus. The hippocampus is located in the middle of both of your temporal lobes. This is the most common type of TLE. The hippocampus is the part of the brain that is primarily involved with our memories.

2. Neocortical or Lateral Temporal Lobe Epilepsy: In this, the seizures start in the outer part of your temporal lobe.

What are the symptoms of this condition?

Symptoms of temporal lobe epilepsy include a strange sensation that occurs before a seizure, called an epileptic aura, and the seizure itself.

Things you may experience during an epileptic aura:

• `Déjà vu`: This is the familiar feeling that comes when you go to a place you've never been to, like "I've been here before." Or, a memory that feels like something that happened before is happening again.
• `Jamais vu`: This is the opposite of `déjà vu`. It is when something that is very familiar to you (for example, a room in your house) suddenly feels strange and unfamiliar.
• A sudden feeling of fear, worry, or anxiety; or anger, sadness, or happiness.
• A strange rolling sensation as if the stomach is coming up from the inside (just like the feeling you get when you're on a roller coaster).
• Increased sensitivity of the senses (such as hearing, seeing, smelling, tasting, or touching things more intensely than usual).

Not everyone gets this `aura`. An `aura` is actually a `focal-aware seizure`. That means that when these symptoms occur, you are conscious and aware of what is happening. This can last from a few seconds to about two minutes.

Other symptoms that can be seen during a seizure:

The following symptoms may occur after the aura:

• Loss of consciousness.
• A blank expression on the face.
• Enlargement of the pupils of the eyes.
• Repetition of the same thing without any meaning (automatisms). For example, pretending to pick something up with your hands, blinking your eyes, pursing your lips, pretending to chew something, swallowing.
• Confusion.
• The inability to speak or understand what is said for a short period of time (aphasia).
• The body is stiff and throbbing.

What causes temporal lobe epilepsy?

The main reason for this is that the nerve cells, or neurons, in your temporal lobe are not communicating properly. Neurons are the ones that send electrical signals to different parts of the brain. When you have a seizure, these neurons send out too many signals without control.

These are some of the main causes of temporal lobe epilepsy:

• Hippocampal sclerosis: This is the damage and loss of neurons and glial cells in the hippocampus.
• Focal cortical dysplasia: An abnormal clustering of neurons in the brain.
• Brain tumors.
• Traumatic brain injury (TBI).
• Infections: Examples include brain abscess, meningitis, and encephalitis.
• Diseases related to blood vessels: For example, `stroke`, `arteriovenous malformations (AVMs)`.
• Genetic variants.
• Unknown causes.

Who is most at risk for this condition?

This condition, called `TLE`, can develop at any age. However, you may be at increased risk if you:

• If you have had a febrile seizure as a child.
• A seizure lasting more than five minutes, or multiple seizures without regaining consciousness (status epilepticus) in a row.
• If you have a congenital disorder or condition such as a brain tumor.
• If you have had a severe head injury (TBI) or brain infection as a child.
• If someone in the family has temporal lobe epilepsy (family history).

About two-thirds of people with `TLE` have had febrile seizures in childhood. Many of these are complex (meaning they last a long time). But, remember, not everyone who has had a febrile seizure will develop `TLE`. It is quite rare.

What are the possible complications of temporal lobe epilepsy?

With TLE, you are at risk of irreversible neurocognitive decline. This means you may have difficulty learning new things, remembering things, making decisions, and concentrating.

The more often you have seizures, and the longer you have had them, the higher your risk of:

• Depression
• Anxiety
• Memory loss
• Sudden Unexplained Death in Epilepsy (SUDEP)

Therefore, it is very important to see a doctor and get proper treatment for `TLE`. This will help prevent complications like these.

How do doctors diagnose this disease?

A doctor diagnoses temporal lobe epilepsy by asking about your symptoms, learning about how the seizure started, performing a neurological examination, and performing any necessary tests. The doctor will also ask you about what happened before and after the seizure. He or she will also review your medical history.

You may not remember what happened during the seizure. If so, it is a good idea to bring someone who was with you when the seizure occurred with you to the doctor. Then they can tell the doctor what they saw.

Tests can help your doctor see what's going on inside your brain. Tests like these may be done:

• MRI (Magnetic Resonance Imaging) scan: Take a clear picture of the brain.
• `EEG (Electroencephalogram)` or `video-EEG` test: Look at the electrical activity of the brain.
• `SPECT (Single Photon Emission Computed Tomography)` scan test.
• `PET (Positron Emission Tomography)` scan.
• `MEG (MEG - Magnetoencephalography)` test.
• Neuropsychological testing: Check how things like memory and attention are.

What are the treatments for temporal lobe epilepsy?

The following can be done as treatments for temporal lobe epilepsy:

• Antiseizure medications.
• Epilepsy surgery.
• Neurostimulation.

In addition, your doctor may also recommend that you make some dietary changes, such as a ketogenic diet. This is a high-fat, low-carbohydrate diet.

Medications for temporal lobe epilepsy

There are many medications available to treat temporal lobe seizures. Some examples are:

• `Brivaracetam`
• `Cenobamate`
• `Carbamazepine`
• `Gabapentin`
• `Lamotrigine`
• `Lacosamide`
• `Levetiracetam`
• `Oxcarbazepine`
• `Pregabalin`
• `Rufinamide`
• `Topiramate`
• `Valproate`
• `Zonisamide`

Your doctor will try one or several medications, in different dosages, to find the one that works best for you.

Important: Some seizure medications can be harmful to the baby during pregnancy. So, be sure to tell your doctor if you are pregnant or planning to become pregnant.

Surgery for temporal lobe epilepsy

If the seizures cannot be controlled with medication, or if these symptoms are caused by something like a brain tumor, the doctor may consider surgery.

Temporal lobectomy (removing part of the temporal lobe) is the most common surgery. However, because the temporal lobe controls so many important functions, the neurosurgeon plans the surgery very carefully to minimize the impact on brain function.

Two less invasive methods are stereotactic radiosurgery and laser ablation . These methods use laser beams or radiation to destroy nerve cells or tissue in the temporal lobe where seizures begin.

Nerve stimulation for temporal lobe epilepsy

If medication doesn't work, or if surgery isn't safe, you may want to consider neurostimulation devices. This involves sending electrical impulses to your temporal lobe through a device that is implanted inside your body. This treatment can gradually reduce the number of seizures you have over time. The main types of devices used for TLE are:

• `Vagus nerve stimulation (VNS)`
• `Responsive neurostimulation (RNS)`
• `Deep brain stimulation (DBS)`

What kind of hope can you have when living with this situation?

How your situation will turn out depends on things like:

• How often do you have seizures?
• How long have you had this condition?
• Your general health.
• Whether irreversible complications have begun.

Many people can control their seizures well with medication. Some people even say that their seizures have completely disappeared after surgery. However, this varies greatly from person to person. Your doctor can give you a more accurate description of your situation.

What are the best times to see a doctor?

If you have ever had a seizure, or think you may have had a seizure, you should definitely see a doctor.

If you have already been diagnosed with temporal lobe epilepsy, call your doctor immediately if you experience any of the following:

• If your seizure lasts longer than five minutes.
• If another seizure comes as soon as the first seizure is over.
• If the frequency and severity of seizures increases.
• If new symptoms or side effects of medications occur.
• If the recovery after the seizure is over is slower than usual, or if the recovery is not complete.

Important questions to ask your doctor

If you have `TLE`, it's a good idea to ask your doctor questions like these:

• What kind of treatment do you recommend for me?
• Are there any side effects of the treatment?
• Is this anti-seizure medication safe if I'm hoping to start a family?
• Can I have epilepsy surgery?

You may not realize how important your temporal lobes are until they stop working 100% properly. Temporal lobe epilepsy (TLE) can affect their function over time. However, a doctor can help you manage TLE seizures and prevent complications.

The treatment for TLE is unique to you. You may need to try different medications and different doses until you find the one that works best for you. Sometimes, medications don't work and surgery may be the best option.

Managing life with epilepsy can be difficult. However, you can get extra help from support groups or by talking to a mental health professional. Your medical team will be with you to answer any questions you may have along the way.

Final Take-Home Message

Dear friend, Temporal Lobe Epilepsy is not something to be afraid of, but it is not something to ignore either.

Remember, you can live successfully with this condition. The most important thing is to follow your doctor's instructions carefully and get the proper treatment.

• If you or someone you know has these symptoms, see a doctor immediately.
• Take your prescribed medication exactly as prescribed, on time. Never stop taking your medication without consulting your doctor.
• If your doctor recommends making some changes to your lifestyle (e.g., a ketogenic diet), try to follow them.
• Stay mentally strong. If necessary, seek counseling. You are not alone.
• It's a good idea to let your family and friends know about this situation as well. Then they can help you.

We hope this information is useful to you. Stay healthy!

` Temporal Lobe Epilepsy, Epilepsy, Seizure, Brain Disease, Neurological Disease, Temporal Lobe Epilepsy, Seizure