temporal lobe seizures « Thread Started on Aug 5, 2005, 1:50pm »
What is it like? Here's a typical story: "I get the strangest feeling—most of it can't be put into words. The whole world suddenly seems more real at first. It's as though everything becomes crystal clear. Then I feel as if I'm here but not here, kind of like being in a dream. It's as if I've lived through this exact moment many times before. I hear what people say, but they don't make sense. I know not to talk during the episode, since I just say foolish things. Sometimes I think I'm talking but later people tell me that I didn't say anything. The whole thing lasts a minute or two."
The features of seizures beginning in the temporal lobe can be extremely varied, but certain patterns are common. There may be a mixture of different feelings, emotions, thoughts, and experiences, which may be familiar or completely foreign. In some cases, a series of old memories resurfaces. In others, the person may feel as if everything—including home and family—appears strange. Hallucinations of voices, music, people, smells, or tastes may occur. These features are called “auras” or “warnings.” They may last for just a few seconds, or may continue as long as a minute or two.
Experiences during temporal lobe seizures vary in intensity and quality. Sometimes the seizures are so mild that the person barely notices. In other cases, the person may be consumed with fright, intellectual fascination, or even pleasure.
The experiences and sensations that accompany these seizures are often impossible to describe, even for the most eloquent adult. And of course it is even more difficult to get an accurate picture of what children are feeling.
Dostoyevsky, the 19th-century Russian novelist, who himself had epilepsy, gave vivid accounts of apparent temporal lobe seizures in his novel The Idiot:
He remembered that during his epileptic fits, or rather immediately preceding them, he had always experienced a moment or two when his whole heart, and mind, and body seemed to wake up with vigor and light; when he became filled with joy and hope, and all his anxieties seemed to be swept away for ever; these moments were but presentiments, as it were, of the one final second…in which the fit came upon him. That second, of course, was inexpressible.
Next moment something appeared to burst open before him: a wonderful inner light illuminated his soul. This lasted perhaps half a second, yet he distinctly remembered hearing the beginning of a wail, the strange, dreadful wail, which burst from his lips of its own accord, and which no effort of will on his part could suppress. Next moment he was absolutely unconscious; black darkness blotted out everything. He had fallen in an epileptic fit.
Who gets it? The two temporal lobes (one on each side of the brain at about the level of the ears) are the most common location for the origin of partial seizures, which start in one localized area, also called a seizure focus. The seizures of temporal lobe epilepsy (TLE) can start at almost any age. Some follow a head injury or an infection that affects the brain, such as meningitis. The cause of others is unknown.
There are no good statistics on how many people have temporal lobe epilepsy, or what groups are most often affected.
Tell me more The most common type of seizure in temporal lobe epilepsy is complex partial seizures. Children with TLE most commonly pause in whatever they're doing and do not respond if spoken to. About 40% to 80% of people with TLE also perform repetitive, automatic movements (called automatisms), such as lip smacking and rubbing the hands together.
Three-quarters of people with TLE also have simple partial seizures, in which they remain fully conscious. Some people have only simple partial seizures and never have a change in consciousness.
Unfortunately, in about 60% of people with TLE, the seizures spread from the temporal lobe to a wider portion of the brain. This process is called secondary generalization. The result is a convulsive (grand mal) seizure.
After the complex partial seizure or secondarily generalized seizure has ended, patents are often confused for several minutes and then gradually recover.
Temporal lobe seizures usually begin in the deeper portions of the brain's temporal lobe. This area is part of the limbic system, which controls emotions and memory. Some individuals with temporal lobe epilepsy may have problems with memory, especially if seizures have occurred for more than 5 years, but these memory problems are almost never severe.
How is it treated? For most people, the seizures of TLE can be completely or at least mostly controlled with the medications for partial seizures. Many seizure medicines can be used, either alone or in combination. The choice for adults depends on not only the type of seizure but also on other factors such as whether the person has other disorders or is taking medication for other conditions.
The choice of medicines to treat TLE in young children is much more limited if only the ones approved for children by the U.S. Food and Drug Administration (FDA) are considered. Only Tegretol (carbamazepine) and Dilantin (phenytoin) are approved to be used alone for very young children with partial seizures. Trileptal (oxcarbazepine) is also approved for children over 4 and Depakote and other valproate medicines are approved for those over 10. Outside the United States, Frisium (clobazam) is used for children over 3 years of age.
The seizure medicines approved by the FDA to be used as add-ons with one of the medications just mentioned are
In practice, however, it is considered not only legal but also ethical for doctors to prescribe medicines for children that have not been FDA-approved for that purpose, if there is evidence or experience to suggest that they are safe and effective. This so-called off-label use of seizure medicines is very common. Parents who have any concern about their child's medication should talk it over with the doctor.
If various seizure medicines have been tried adequately without success, then other treatments may be used. Some people with temporal lobe seizures are candidates for surgery. The operation (called a temporal lobectomy) usually removes only the abnormal part of the temporal lobe, not the entire lobe. Many also benefit from vagus nerve stimulation or the ketogenic diet.
What's the outlook? The outlook for people with TLE varies greatly, depending on the cause of the seizures. About half of children with TLE outgrow the disorder. Other people, for whom various seizure medicines are unsuccessful, may be evaluated for surgery or other treatments. Many achieve good or complete control of their seizures.
Re: temproal lobe seizures « Reply #1 on Aug 5, 2005, 1:52pm »
Symptoms: The early warning symptoms (called an aura) include: Abnormal sensations Epigastric sensations ("a funny feeling in my gut," "stomach rising,") Hallucinations or illusions (vision, smells, tastes, or other sensory illusions) Sensation of deja vu, recalled emotions or memories Sudden, intense emotion not related to anything occurring at the time Consciousness maintained during the seizure or spell (partial) Consciousness reduced or lost during the seizure or spell (partial complex) Movement disturbances include: Abnormal mouth behaviors Lip smacking Chewing or swallowing without cause Profuse salivation "slobbering" Abnormal head movements Forced turning of the head Forced turning of the eyes Usually in the direction opposite of the location of the lesion Repetitive movements, such as picking at clothing Rhythmic muscle contraction and relaxation (rare) -- affecting one side of the body, one arm, leg, part of face, or other isolated area Abnormal sensations include: Numbness, tingling, crawling sensation Occurring in only one part of the body or spreading Preceding motor symptoms Sensory hallucinations (visual, hearing, touch, etc.) Autonomic symptoms include: Abdominal pain or discomfort Nausea Sweating Flushed face Dilated pupils (eyes) Rapid heart rate/pulse Other symptoms include: Changes in vision, speech, thought, awareness, personality Loss of memory (amnesia) regarding events around the seizure (partial complex seizure)
Re: temproal lobe seizures « Reply #2 on Aug 5, 2005, 1:58pm »
Definition
A partial complex seizure is a brief and temporary alteration in brain function. It is caused by abnormal electrical activity in a specific, discrete area of the brain. The seizure is characterized by a change in alertness or awareness, behavioral or emotional symptoms, and temporary loss of memory. See also temporal lobe seizure.
Causes, incidence, and risk factors Return to top
Partial complex seizures may occur at any age, as a single episode or as a repeated, chronic condition (seizure disorder, epilepsy). They are uncommon in very young children.
During the normal functioning of the brain, information is transmitted from nerve cell to nerve cell by an electrochemical process. This process can be detected as electrical activity by an electroencephalograph (EEG). Abnormal patterns of electrical activity are associated with seizures.
Given sufficient circumstances, any person will have a seizure. Partial complex seizures are usually the result of abnormal electrical activity in the temporal lobes of the brain. The most common cause is when a specific area of the brain has been damaged by lack of oxygen, trauma, brain tumors, or discrete brain lesions of any sort.
In tissue studies, about 47% of children with partial complex seizures were found to have hippocampal sclerosis (hardening in the area of the brain called the hippocampus).
Symptoms Return to top
alteration in consciousness confusion, disorientation decreased awareness/alertness lack of concentration loss of judgment difficulty talking delirium (rare) eye or head deviation to one side automatisms (complex, purposeless movements such as picking at clothing) abnormal behaviors may appear drowsy or intoxicated normal activities (such as eating or driving) may continue automatically sensory hallucinations smell, impaired (somewhat common) abnormal taste (somewhat common) visual hallucinations auditory (hearing) hallucinations recalled emotion (somewhat common) sense of unreality sense of deja vu abdominal pain or discomfort nausea sweating flushed face dilated pupils (eyes) rapid heart rate/pulse chest pain difficulty breathing, absent breathing changes in vision, speech, thinking, awareness, personality complex hallucinations or illusions a loss of memory (amnesia) regarding events surrounding the seizure (very common) may be confused for a short period of time after the seizure Note: Symptoms commonly persist for longer than 15 seconds. Typically they last no longer than 2 minutes.
Re: temproal lobe seizures « Reply #3 on Aug 5, 2005, 2:04pm »
Importantly, most adults with ADHD do not have a "pure" form of the disorder. Comorbidity is more likely to be the rule than the exception. It is not clear whether these comorbid psychiatric conditions are a psychologic effect of preexisting ADHD or are simply associated with ADHD.2 For example, substance abuse may have developed as a way to reduce the frustration arising from distractibility, inattention and impulsivity. If a comorbid psychiatric disorder exists in a patient with ADHD, the patient should be educated about the ADHD symptoms that will resolve with stimulant therapy and the symptoms of the other psychiatric condition that may warrant additional treatment.
In addition to the physical examination and laboratory findings, a thorough history is valuable in the differential diagnosis. Medical conditions that may mimic adult ADHD include hyperthyroidism, petit mal and partial complex seizures, hearing deficits, hepatic disease and lead toxicity.13 In addition, sleep apnea and drug interactions should be considered as possible causes of inattention and hyperactivity.13,15 Patients with a history of head injury may also have problems with attention, concentration and memory.16
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