Temporal lobe seizure

Diagnosis   

When visiting your healthcare provider for seizures, they will inquire about your medical history and the characteristics of your seizures. They may ask about the duration of the seizures, your experiences before, during, and after the event, the location and circumstances surrounding the seizure’s onset, and potential triggers such as stress, sleep deprivation, flashing lights, intense exercise, or loud music. Additionally, your provider may request to speak with individuals who witnessed your seizures to gather their observations. It can be beneficial to have a video recording of a seizure to show your healthcare provider, and keeping a diary of seizure occurrences can be helpful as well. To determine the cause of your seizures and assess the likelihood of future episodes, your provider may order various tests, including: 

• Neurological exam: This examination evaluates your behavior, motor skills, and mental function to assess the health of your brain and nervous system. 
• Blood tests: A blood sample is taken to check for signs of infections, genetic conditions, blood sugar levels, or electrolyte imbalances. 

• Electroencephalogram (EEG): Electrodes are placed on your scalp to record the electrical activity of your brain. The resulting wavy lines on the EEG recording can reveal patterns that indicate the likelihood of future seizures. Additionally, an EEG helps rule out other conditions that resemble epilepsy. 
• Video EEG: This is an extended version of the regular EEG, requiring admission to the hospital for several days. During the test, antiseizure medications are temporarily stopped to capture seizures on the EEG while recording your movements on video. This combination of information helps identify the origin of your seizures and their impact on your functioning. 
• Magnetoencephalography (MEG): This test evaluates your brain’s active functioning and detects abnormal changes. 
• Stereoelectroencephalography (SEEG): Electrodes are placed at various depths in the specific area of interest within your brain, creating a 3D view of the seizure site. 
• Computerized tomography (CT) scan: X–rays are used to generate cross–sectional images of your brain, providing insights into potential causes of your seizures such as tumors, bleeding, or cysts. 

• Magnetic resonance imaging (MRI): This technique employs strong magnets and radio waves to produce detailed images of your brain, aiding in the identification of seizure causes. 
• Positron emission tomography (PET): A small amount of low–dose radioactive material is injected into your vein to visualize active areas of the brain. PET scans can reveal the origin of seizures. 
• Single–photon emission computerized tomography (SPECT): A SPECT test involves injecting a low–dose radioactive tracer into a vein to create a detailed 3D map of blood flow in the brain during a seizure. SPECT, particularly a variation called subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM), can provide even more detailed results. 

Treatment

There are several treatment options available for managing temporal lobe seizures, including medication, dietary changes, surgery, laser therapies, and electrical brain stimulator devices. The objective of these treatments is to effectively control and reduce the frequency of seizures in individuals with temporal lobe epilepsy. The specific treatment chosen depends on the individual’s condition and the recommendations of their healthcare provider. The primary aim of seizure treatment is to find the most effective therapy while minimizing side effects. In some cases, treatment may not be initiated until a person experiences more than one seizure, as not everyone who has a single seizure will have another. 

• Medications: When considering treatment options for temporal lobe seizures, it is important to discuss potential side effects with your healthcare provider. While there are many medications available, some individuals may not achieve seizure control with drugs alone. Common side effects of these medications include fatigue, weight gain, and dizziness. Additionally, it is crucial to inquire about the potential interactions between your seizure medications and any other medications you may be taking. For instance, certain anti–seizure medications can reduce the effectiveness of oral contraceptives.  
• Surgery: Surgery is aimed at preventing seizures and can be achieved through traditional methods where surgeons remove the specific brain area responsible for initiating seizures. Alternatively, in some cases, MRI–guided laser therapy can be utilized as a less invasive approach to eliminate the damaged tissue causing seizures. Successful outcomes are typically observed in individuals whose seizures consistently originate from a single location in the brain, while surgery may not be feasible if seizures arise from multiple areas or if the seizure focus cannot be identified. Similarly, if the affected brain area serves essential functions, surgery may not be a viable option. 
• Vagus nerve stimulation: The stimulator is surgically implanted beneath the skin on your chest, while electrical lead wires are positioned around the vagus nerve in your neck. The vagus nerve originates in the lower region of the brain and extends down to the abdomen. This implant sends signals to the brain that help prevent seizures by inhibiting their occurrence. While undergoing vagus nerve stimulation, it is possible that you may still require medication, although the dosage may be reduced.  

• Responsive neurostimulation: The implanted device beneath your scalp monitors brain wave patterns and delivers controlled electrical pulses to stop, shorten, or potentially even prevent the onset of seizures.  
• Deep brain stimulation: A surgeon surgically inserts electrodes into specific regions of the brain. These electrodes generate electrical impulses that help regulate brain activity, effectively preventing seizures. The electrodes are connected to a pacemaker–like device, which is implanted beneath the skin of the chest. This device is responsible for controlling the intensity of the stimulation produced. 
• Dietary therapy: Seizure control can be enhanced by following a ketogenic diet, which is characterized by high fat intake and low carbohydrate consumption. However, adhering to this diet can be challenging due to its restrictive nature. Although variations such as the low glycemic index and modified Atkins diets offer some benefits, they are generally not as effective as the traditional ketogenic diet. When medications fail to effectively control seizures, a ketogenic diet is sometimes considered as an alternative option.  
• Laser ablation: Surgeons employ magnetic resonance imaging (MRI) to assist them in targeting scar tissue within the temporal lobe that is responsible for triggering seizures. By utilizing a laser, they are able to precisely direct heat towards the affected tissue, effectively eliminating the source of the seizures.