Epilepsy is a chronic neurological condition that causes episodes of abnormal electrical activity in the brain, resulting in seizures. Temporal lobe epilepsy (TLE) seizures begin in the temporal lobe and often involve unusual feelings, movements, or behaviors.

During a TLE seizure, a person may remain conscious or lose consciousness.

Potential causes of TLE include febrile seizures and some types of brain injury, but, often, the causes remain unknown.

It is usually possible to control TLE seizures with treatments such as medication, surgery, and dietary changes.

Keep reading to learn more about TLE, including its causes, symptoms, and treatment options.

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Of the types of epilepsy, focal epilepsy is the most common. Focal epilepsy involves seizures that begin in one area of the brain.

TLE is the most common type of focal epilepsy. According to the Epilepsy Foundation, TLE occurs in around 6 out of 10 people with focal epilepsy. TLE seizures begin or occur in one or both temporal lobes, which are involved in functions related to emotions, memories, and sensory information.

There are two types of TLE, and these relate to the area of the temporal lobe in which seizures occur.

The most common type, mesial temporal lobe epilepsy (MTLE), occurs in the middle or inner area of the temporal lobe. MTLE seizures often involve the hippocampus or nearby regions.

The other type, neocortical TLE, originates in the side or outer region of the temporal lobe.

There are several potential causes of TLE, though often the cause is unknown. Most of the time, TLE starts when a person is aged 10–20 years, but it can occur at any age.

Some possible causes of TLE include:

  • febrile seizures
  • brain injury at a young age
  • head trauma
  • brain infections, including encephalitis or meningitis
  • structural changes in the temporal lobe, including the hippocampus
  • genetics

The symptoms of TLE seizures relate to a person’s awareness during a seizure. These classifications include focal onset aware seizures and focal impaired awareness seizures.

Focal onset aware seizures

During a focal onset aware seizure, a person remains alert. These types of seizures often include strange feelings or sensations known as auras. However, auras do not occur in all people who have TLE, and in those who do have them, not everyone remembers them.

Epilepsy auras are the earliest symptoms of a seizure, and they may indicate an oncoming seizure. Common auras include strange feelings such as fear, joy, or anxiety.

They may also involve unusual odors, tastes, or sounds. Auras may involve digestive discomfort, nausea, or the feeling of butterflies in the stomach. People can also experience auras that cause a feeling of deja vu or a sensation that begins in the stomach and rises to the chest or throat.

Focal impaired awareness seizures

If a person loses awareness during a seizure, it is known as a focal impaired awareness seizure. They may repeatedly swallow, chew, or smack their lips. They may also stare at or fumble with their hands.

During the seizure, the person may also have difficulty speaking or understanding language. They may also be unable to respond to people or be unaware of their surroundings, even if they appear to be aware.

After a temporal lobe seizure, a person may experience confusion and speech difficulties or feel extremely weak or sleepy. They may also be unable to remember the seizure.

A neurologist can use several tests to provide a clinical diagnosis of TLE.

For example, they can perform an MRI scan to see if there are structural changes in the temporal lobe, which can be present with TLE. Usually, however, there is no visible structural problem with this type of epilepsy.

They may also use an EEG test. These show brain waves and electrical activity when a person is awake or asleep. If a person has MTLE, it may be difficult to diagnose unless the EEG records a seizure.

A person may also be able to provide detailed descriptions of their seizures. A witness can also share what they observed during the seizure.

TLE treatment involves taking steps to prevent or limit seizures. In order to determine the best treatment plan, a person can visit an epileptologist, which is a neurologist specializing in epilepsy. They will likely suggest options including medications, surgery, and devices.

Many people use antiseizure medications to control their seizures. Epilepsy surgery is an option for people whose condition does not improve with medications. Undergoing surgery to remove a lesion that is causing seizures may stop or reduce seizures, especially if the person has the procedure as soon as possible.

If medications and surgery are not effective, some people who have epilepsy may use a vagus nerve stimulation or responsive neurostimulation device.

Following certain diets — such as the modified Atkins diet, ketogenic diet, or low glycemic diet — may also help some people with epilepsy. However, people should discuss these options with a doctor first and not use them as a replacement for traditional treatment methods, but rather as an accompaniment.

Learn more about epilepsy and the keto diet here.

Learn more about remedies for epilepsy here.

There are several risk factors associated with TLE.

A childhood febrile seizure is the most common risk factor, especially if the seizure was severe. If a person has a history of febrile seizures, they are also more at risk. That said, most people who have febrile seizures do not develop TLE.

Some common risk factors for TLE include:

  • infections, including encephalitis or meningitis, at a young age
  • brain injury
  • injury during birth
  • structural changes in the temporal lobe, including brain malformations or tumors
  • head trauma involving a loss of consciousness

TLE is a chronic brain condition involving seizures in the temporal lobes of the brain. The cause of a TLE seizure is often unknown.

During a TLE seizure, a person may remain alert and experience auras. Alternatively, they may lose awareness and the ability to understand language.

It is possible to use medication, surgery, and devices to control TLE. Many people successfully reduce or eliminate seizures.

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