Temporal Lobe Epilepsy

Clinic

• TLE is characterized by Recurrent, Unprovoked focal seizures that originate in the temporal lobe and last about 1-2 minutes.
• It is the most common form of focal seizures.
• It may spread from temporal lobe to other areas in brain and become a bilateral seizure..

Anatomic Types:

1. Mesial temporal lobe epilepsy (MTLE) arising in Hippocampus , Parahippocampal gyrus and Amygdala
2. Lateral temporal lobe epilepsy (LTLE), the rarer type, arising in the neocortex at the outer (lateral) surface of the temporal lobe, which is characterized by auditory or visual features. Autosomal dominant lateral temporal lobe epilepsy (ADLTLE) is a rare hereditary condition.

Key features

When a seizure begins in the temporal lobe, its effects depend on the precise location of its point of origin, its locus. The newer classification uses three key features:

1. Where the seizures begin?
2. Level of awareness during a seizure
3. Other features

Level of awareness

Focal aware seizures

• Focal aware seizures are often called "auras" when they serve as a warning sign of a subsequent seizure. Regardless, an aura is actually a seizure itself, and such a focal seizure may or may not progress to a focal impaired awareness seizure. People who experience only focal aware seizures may not recognize what they are, nor seek medical care.
• Level of consciousness is not altered during the seizure.

Abnormal sensations

• Déjà vu (a feeling of familiarity), jamais vu (a feeling of unfamiliarity)
• Amnesia; or a single memory or set of memories
• Sudden sense fear, anxiety and Nausea
• Auditory, visual, olfactory, gustatory, or tactile Hallucinations
  • Olfactory hallucinations often seem indescribable to patients beyond "pleasant" or "unpleasant".
• Visual distortions such as macropsia and micropsia
• Dissociation or De-realization
• Synesthesia (stimulation of one sense experienced in a second sense) may transpire.
• Dysphoric or euphoric feelings, fear, anger, and other emotions may also occur. Often, the patient cannot describe his sensations.

• Myself suggestion: Focal aware seizures maybe related to Mesial temporal lobe epilepsy

Focal aware TLE

Entities	RBS	TBE	NVCJD
Fear	+++	+++
Hallucination	+++	+++	+++
Auditory, Visual			+++
Olfactory H.		+++
Memory weakness	+++	+++	+++
Anger	+++		+++

Miasms:

• RBS:
• TBE: Olfactory hallucination + Temporal lobe seizure
• NVCJD: Auditory / Visual Hallucination

Focal impaired awareness seizures

• It usually begins with a focal aware seizure, then spread to a larger portion of the temporal lobe, resulting in impaired consciousness.

Autonomic / Psychic features:

• Motionless staring
• Automatic movements of the hands or mouth
• Confusion and disorientation
• Altered ability to respond to others / Unusual speech
• Transient aphasia (losing ability to speak, read, or comprehend spoken word)
• Aura which lasts 1–2 minutes.
• Postictal confusion

• Myself suggestion: Focal impaired awareness seizures maybe related to Lateral temporal lobe epilepsy

TLE with Unconsciousness Black Box

Entitie	Miasm
Psychosis Coma Jerking Aphasia Apathy	JE

Focal to bilateral seizures

• Seizures which begin in the temporal lobe, and then spread to involve both sides of the brain are termed focal to bilateral.
• Where both sides of the brain or the whole brain are involved from the onset the seizures are known as generalized seizures and may be tonic clonic.
• The arms, trunk, and legs stiffen (the tonic phase), in either a flexed or extended position, and then jerk (the clonic phase). These were previously known as grand mal seizures.
• It causes a loss of consciousness and violent muscle contractions. It's the type of seizure most people picture when they think about seizures.
• A grand mal seizure — also known as a generalized tonic-clonic seizure — is caused by abnormal electrical activity throughout the brain. Usually, a grand mal seizure is caused by epilepsy. But sometimes, this type of seizure can be triggered by other health problems, such as extremely low blood sugar, a high fever or a stroke.
• Many people who have a grand mal seizure never have another one and don't need treatment. But someone who has recurrent seizures may need treatment with daily anti-seizure medications to control and prevent future grand mal seizures.

Entities

Seizure , Tonic-Clonic

Miasm

• EEE/ WEE
• VSV