Patients with temporal lobe epilepsy with prior cfc had an excellent outcome after surgery, by contrast with an unfavourable response to drug therapy. Epilepsy surgery has been shown to be effective in the treatment of medically intractable tle. Temporal lobe epilepsy tle is the most common form of focal epilepsy that may secondarily generalize. Complex partial seizures, as in psychomotor temporal lobe epilepsy, usually, but not always, originate in the temporal lobe of the brain, often with a preceding aura. Herbal remedies should also be used cautiously because some of their ingredients can interact with epilepsy medication. 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. Patients refractory to drugs should be evaluated for resective surgery. It can be hard for people with tle to become completely seizure free with seizure medicines alone, though medicines may lower the number of seizures. Temporal lobe epilepsy tle is the most common form of focal partial epilepsy. Advances in electrophysiology and neuroimaging have led to a more precise localization of the epileptogenic zone within the temporal lobe. Temporal lobe epilepsy tle is divided into two categories.
Researchers develop new therapeutic concept for treatment. Etiology and pathogenesis of temporal lobe epilepsy. Pdf surgical treatment of temporal lobe epilepsy semir. Temporal lobe epilepsycausessignssymptomstreatment. Tle is the most common form of epilepsy with focal seizures. It is not unusual for a person to have an occasional temporal lobe seizure despite taking the correct amount of.
Despite the description by hughlings jackson, 1,2 the fact that temporal lobe epilepsy is the most common focal epilepsy was not appreciated. Postictal noserubbing is commonly seen in temporal lobe epilepsy, and in 90% of cases is ipsilateral to the focus11. Furthermore, there was no method to specifically localize the seizure onset. Resective surgery is the most effective treatment for tle.
Temporal lobe epilepsy tle is the commonest form of focal epilepsy and represents almost 23 of cases of intractable epilepsy managed surgically. The management of epilepsy in children and adults mja. Of the 1,200,000 americans with partial epilepsy, temporal lobe epilepsy tle occurs in more than 400,000. The superior surface of the temporal lobe normally hidden within the lateral sulcus includes the transverse temporal gyri, which contain the primary auditory cortex. Surgical techniques for the treatment of temporal lobe. The current controversies regarding the necessity for local anaesthesia in temporal lobe epilepsy operations concern the utility of electrocorticography in surgical decision making, its relationship to seizure outcome and the value of intraoperative language mapping in dominant temporal lobe resections. Epilepsy, classification, status epilepticus, treatment, pregnancy. Origin and propagation of interictal discharges in the. Surgical treatment of refractory temporal lobe epilepsy. People with drugresistant medial temporal lobe epilepsy have a higher risk for memory and mood difficulties.
It has unique symptoms and is also associated with personality changes. Temporal lobe epilepsy is the most common type of epilepsy, in which the seizures originate in the temporal lobe of the brain. The term temporal lobe epilepsy tle was included in the classification of the ilae in 1989 under the group of localization related symptomatic epilepsies characterized by seizures with sp e. Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy, as it has a high seizurefree rate. Epilepsy patients who continue to have seizures despite treatment trials with. Mtle with mts is the most surgically amenable epilepsy diagnosis and the results of epilepsy surgery are clearly superior.
Treatment for temporal lobe epilepsy depends on the cause, but most patients are able to manage their disorders with anticonvulsant drugs such as phenytoin or carbamazepine. The term temporal lobe epilepsy tle was included in the classification of the ilae in. Temporal lobe epilepsy an overview sciencedirect topics. For instance, anteromedial temporal lobe hypometabolism in the setting. These early feeling does not necessarily occur in all the patient suffering from temporal lobe epilepsy.
Thus, application of the newly developed techniques of. The surgical results were discouraging in patients with temporal lobe epilepsy without history of any febrile convulsions and without solid brain tumours. Patients who take their medications and attend regular checkups have less frequent and severe seizures, and some people stop having episodes altogether. Temporal lobe seizures may be difficult to completely control with medication alone. Temporal lobe epilepsy definition of temporal lobe. Temporal lobe epilepsy tle is the most common form of medically intractable epilepsy. 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. St johns wort, a herbal remedy used for mild depression, isnt recommended for people with epilepsy because it can affect the levels of epilepsy medication in the blood and may stop the medicine working properly. Patients often complain of poor memory for recent events, and this may get worse as the epilepsy continues. Patients with tle often show impairments in attention, memory, mental processing speed, executive functions.
Imaging studies and eeg confirm the diagnosis, whereas treatment is primarily surgical. Amnesia is the rule for the blank spell and the automatism. Structures that constitute the mesial temporal lobe, primarily hippocampus, are hypothesized to be the origin of excitatory signals. Epidemiology of temporal lobe epilepsy volume 27 issue s1 samuel wiebe. Interictal psychosis the prevalence is reported to be 4 10% in patients with epilepsy, mainly in those with temporal lobe epilepsy7,8,9. Pdf surgical techniques for the treatment of temporal. A history of febrile seizures especially complex febrile seizures is common in tle and is frequently associated. Improved cerebral function in mesial temporal lobe epilepsy after subtemporal amygdalohippocampectomy temporal plus epilepsy is a major determinant of temporal lobe surgery failures source propagation of interictal spikes in temporal lobe epilepsy.
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. Emergence of temporal lobe surgery for epilepsy epilepsy. The most common organic substrate for mtle is mesial temporal sclerosis mts. Temporal lobe epilepsy list of high impact articles. Advances in electrophysiology and neuroimaging have led to a more precise localization of the epileptogenic. Temporal lobe epilepsy is the term used when seizures occur in the temporal lobe areas of the brain. Focal epilepsies include idiopathic locationrelated epilepsies ilre, frontal lobe epilepsy, temporal lobe epilepsy, parietal lobe epilepsy and occipital lobe epilepsy.
A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure. Diagnosis and treatment of temporal lobe epilepsy orrin devinsky, md departments of neurology, neurosurgery, and psychiatry, new york university school of medicine, new york, ny of the 1,200,000 americans with partial epilepsy, temporal lobe epilepsy tle occurs in more than 400,000. It is a chronic neurological condition characterized by recurrent, unprovoked epileptic seizures epilepsy which originate in the temporal lobe of the brain. Temporal lobe epilepsy tle is the commonest form of focal epilepsy. In this procedure, surgeons use magnetic resonance imaging mri to guide the use of a laser. Treatment after a first tonicclonic seizure halves the two year risk of seizures from approximately. Characteristics and treatment of temporal lobe epilepsy. For patients who had mesial temporal lobe epilepsy and disabling seizures for no more than 2 consecutive years following adequate trials of 2 brandname aeds, engel et al found that resective surgery plus aed treatment resulted in a lower probability of seizures.
Despite the variability in surgical techniques and in the extent of resection, the overall outcomes of. It is a chronic disorder and clinically resembles chronic. There was then a hope, even an expectation, that surgery might benefit psychosis as it. Temporal lobe epilepsy surgery, also called temporal lobectomy or resection, is a treatment for epilepsy when patients do not respond to antiepileptic medication. Temporal lobe seizures are usually stereotypic in their symptoms. Temporal lobe epilepsy surgery barnesjewish hospital. Etiology and pathogenesis of temporal lobe epilepsy jama. Epidemiology of temporal lobe epilepsy canadian journal.
Typically frontal or temporal lobe onset often stereotyped for the individual patient average duration minutes simple partial onset can be followed by impaired consciousness many times will progress to a generalized seizure frequently seen in adult onset epilepsy. Correlations between spike dipole modelling and 18 ffluorodeoxyglucose pet data. About onethird of patients with tle may become resistant to medical therapy and require surgical treatment. Gamma knife radiosurgery for mesial temporal lobe epilepsy. The most common surgery for epilepsy is a temporal lobectomy, which is the removal of a portion of the temporal lobe. Effects of chronic temporal lobe epilepsy on memory functions. That evaluation requires identification of a focus of onset of seizures, as well as establishing that the focus is in an area of the brain that can be removed with a low risk of new. Diagnosis and management of epilepsy in adults scottish. As the name implies, there are many different cognitive, affective, and psychomotor symptoms. Cognition, memory and functional ability are all impaired as a result of seizure activity.
Most of the time people do not remember experiencing any aura. Temporal lobe epilepsy pathophysiology and mechanisms. Temporal lobe epilepsy is a form of epilepsy that originates in the temporal lobe of the brain. Focal epilepsy may be treated with medication, and occasionally with diet, nerve stimulation or surgery, especially if the condition is due to a scar or other lesion in the brain. Temporal lobe seizures are usually stereotypic in their symptoms and duration. Secondary generalisation is much less common than in extra temporal lobe epilepsy. Temporal lobe epilepsy is the most common epilepsy of adulthood, and despite a considerable genetic impact, few genetic alterations are known. Temporal lobe epilepsy tle is a disorder of the nervous system due to unprovoked seizures originating from the temporal lobe. The laser is directed at scar tissue in the temporal lobe region that is causing seizures. A typical sequence is an aura followed by arrest of motor behavior, blank stare, and automatisms.
Temporal lobe epilepsy is considered to be one of the most common types of epilepsy. Temporal lobe epilepsy may be more likely to cause long term problems in memory. The temporal lobe is responsible for the emotion process and the shortterm memory. Seizures and epilepsy diagnosis and treatment epilepsy centers. Ask for treatment for other factors that may be contributing, for example. Initial management of patients with temporal lobe epilepsy is with antiepileptic drugs, but these control seizures in only half the patients. Temporal lobe epilepsy is the most common cause of partial or focal seizures. This procedure involves removing part of the temporal lobe of the brain.
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