Temporal lobe epilepsy (TLE) is an epileptic syndrome that includes seizures originating in the mesial structures and lateral temporal neocortex. It represents the most frequent epilepsy of onset during youth and the most frequently recognized among the focal or partial epilepsies.
The main consequence is manifested in the form of social stigma, which occurs when seizures are not controlled. It is therefore important that these patients are managed by epilepsy experts who can avoid the consequences of stigmatization.
Is it important to recognize TLE?
After evaluating a patient in detail, neurologists must have a diagnostic hypothesis about which epileptic syndrome the patient has based on interviews with the patient, but also with witnesses and family members, explaining the symptoms they see in the patient and allowing them to conclude which types of seizures the patient suffers from. It is very important to recognize the type of epilepsy early in order to treat it in the best possible way from the beginning. The most important cause of TLE is mesial temporal sclerosis (MTS).
What are the symptoms of TLE?
The patient may present with complex partial seizures with disturbance of consciousness, simple partial seizures without disturbance of consciousness and secondary generalized convulsive seizures. Auras are very frequent and characteristic. They are symptoms perceived only by the patient and not seen by witnesses. Seizures may spread to neighboring structures such as the frontal lobe. After the seizure there is a period of confusion lasting a few minutes.
Patients with epilepsy often present with comorbid neuropsychological and neuropsychiatric manifestations. Among the most important neuropsychological deficits is immediate memory loss, and among the neuropsychiatric disorders are depression and anxiety.
What are the causes of ELT?
A history of febrile seizures in childhood or a history of meningoencephalitis before the age of 4 or 5 years are the most frequent causes of TLE, especially if hippocampal atrophy is observed.
Other unrelated causes include dysplasias, i.e. a malformation of cortical development at the level of the hippocampus and temporal amygdala, traumatic or vascular causes, cavernous angiomas, temporal lobe tumors, gliomas, oligodendtogliomas and infections. There are also genetic causes of TMS.
What tests should be performed to diagnose TLE?
In addition to the clinical history, an MRI and electroencephalography should be performed. If the patient is refractory to some drugs, then a pre-surgical analysis with electroencephalographic video and other neurophysiological or neuropsychological studies may be performed.
It should be taken into account that many patients are candidates to be cured by surgery if they are refractory and more than half of the patients are free of seizures with a good pre-surgical study.
How is TLE treated?
Treatment is pharmacological. However, if the TLE resists medication, surgery is required, which consists of removal of the epileptogenic area under study.
On the other hand, if it is an EMT with hippocampal atrophy, the amygdala and hippocampus are selectively resected, or resection is performed. Finally, if the lesion is in the temporal neocortex, the responsible lesion is removed with epilepsy surgery criteria, or a wide anterior temporal resection is performed.