What to know about temporal lobe epilepsy hallucinations

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A person who has TLE hallucinations may experience:

• smelling an unpleasant smell
• hearing a monotone noise, such as a humming or ringing
• hearing a complex sound, such as people talking
• seeing things that are not there
• seeing things in an unusual way, such as warping of objects or faces

The type of hallucination a person has may depend on the form of TLE they have and when it occurs during the seizure.

Types of temporal lobe epilepsy

TLE is the most common form of focal epilepsy. Focal epilepsy is a type of epilepsy that only affects one area of the brain.

There are two types of TLE: mesial TLE and lateral TLE.

Mesial TLE affects the internal areas of the temporal lobe. It is the most common form of TLE. People with mesial TLE may experience hallucinations involving smell and taste.

Lateral TLE affects the outer area of the temporal lobe. It is very rare.

Researchers note that people with lateral TLE are likely to have sensory hallucinations, such as hearing sounds. A 2019 case report details a 65-year-old man with lateral TLE who experienced complex visual and auditory hallucinations, among other symptoms.

Learn more about TLE.

Aura phase

A person who has TLE may experience hallucinations during an aura. Some people with epilepsy experience auras as the first sign of a seizure. Auras are changes in:

• thought
• feeling
• behavior
• sensation

These hallucinations can affect a person’s:

• hearing
• taste
• sense of smell
• sight

Ictal phase

A person with TLE may also experience hallucinations during the ictal stage of a seizure. The ictal stage is the time frame from the first symptoms of a seizure until the end.

Sometimes, visual hallucinations involving distortion or memories may occur during the ictal phase.

Learn more about the stages of a seizure.

There is limited information regarding the specific cause of hallucinations in TLE.

Epileptic seizures occur when neurons, a form of brain cell, release an excess of electrical discharge.

When excessive neuron activity occurs in areas of the brain related to sensory processes, it may cause specific types of hallucinations. The temporal lobe is involved in many sensory processes, such as hearing and vision.

Research from 2016 notes that complex hallucinations in TLE may come from the limbic structures of the temporal lobe.

The limbic system is part of the brain involved with:

• emotions
• controlling expressions of fear, joy, and anger
• sexual behavior
• memory
• involuntary functions, such as eating, sleeping, and bladder activity

There are various treatments a doctor can use to manage a person’s TLE symptoms. These include:

• anti-epilepsy medications, such as lamotrigine, gabapentin, and levetiracetam
• anterior temporal lobectomy (ATL), a form of surgery that removes part of the temporal lobe
• selective amygdalohippocampectomy (AHP), a surgery that removes part of the mesial structures of the brain
• vagus nerve stimulation (VNS), a surgical implant that sends regular electrical impulses to the brain
• responsive neurostimulation (RNS), an implant that helps prevent oncoming seizures
• ketogenic diet, or “keto diet,” which involves consuming few carbohydrates and more healthy fats

A person’s doctor can advise on which treatments or surgery they recommend based on the individual’s circumstances.

In addition to hallucinations, some symptoms of TLE seizures may include:

• upset stomach or nausea
• fear, anxiety, or panic
• feelings of deja vu
• feelings of not recognizing familiar things
• motionless staring
• dilated pupils
• lip-smacking
• convulsions
• memory loss
• difficulty speaking
• confusion
• loss of consciousness

It is best for a person to tell their doctor about any symptoms they experience with TLE seizures. Their doctor can recommend ways to minimize symptoms and help keep a person safe during seizures.

If a person is experiencing TLE hallucinations that they cannot control with their current treatment, it is recommended they contact their doctor. A doctor may change the medication a person is taking or recommend other treatments.

A person who still experiences seizures after trying at least two different anti-seizure medications should speak to their doctor as soon as possible.

Here are some more frequently asked questions about TLE and hallucinations.

What type of hallucination is most suggestive of temporal lobe epilepsy?

The kind of hallucinations a person experiences may depend on what form of TLE they have.

A person with mesial TLE may have hallucinations involving taste and smell. A person with lateral TLE may experience hallucinations involving sound or visuals.

Can epilepsy cause visual hallucinations?

Yes, certain forms of epilepsy, including TLE, can cause a person to see things that are not there. TLE can also cause a person to see objects or people in distorted ways.

What are the psychiatric symptoms of temporal lobe epilepsy?

Research from 2021 notes that psychiatric symptoms may occur alongside TLE. These symptoms may include:

• anxiety
• depression
• interictal dysphoric disorder (IDD), a condition caused by epilepsy that can lead to mood or behavioral issues
• cognitive, learning, or behavioral impairment

TLE is a form of epilepsy that affects the temporal lobe. It can cause a person to experience several different symptoms, including hallucinations.

A person with TLE may experience hallucinations that involve taste, sound, smell, or vision. The type of hallucination a person has may depend on the type of TLE they have.

Symptoms of TLE can be managed using treatments such as medication or surgery. A person should contact their doctor if they experience hallucinations they cannot control with their current treatment.