What is the treatment for temporal lobe epilepsy?

From the Guidelines

The treatment for temporal lobe epilepsy typically begins with antiseizure medications, with first-line options including carbamazepine, lamotrigine, levetiracetam, and oxcarbazepine. However, it's essential to consider the potential effects of these medications on reproductive function in women with temporal lobe epilepsy, as discussed in a study published in the Journal of Neurology, Neurosurgery and Psychiatry 1. This study highlights the importance of evaluating and managing reproductive dysfunction in women with epilepsy, particularly those with temporal lobe epilepsy.

Some key points to consider when treating temporal lobe epilepsy include:

• The potential for antiepileptic drugs to decrease or increase biologically active serum sex hormone levels, which can lead to reproductive dysfunction 1
• The risk of hypothalamic amenorrhoea, which has been found in 12% of women with temporal lobe epilepsy, compared to 1.5% of the general population 1
• The potential for earlier menopause in women with epilepsy, with 4% of women with temporolimbic epilepsy experiencing primary gonadal failure with amenorrhoea and FSH values above 50 mIU/ml in their third decade of life 1
• The importance of monitoring and managing menstrual disturbances, such as those caused by enzyme induction in carbamazepine-treated women with epilepsy, which can lead to low oestradiol and a low oestradiol/SHBG ratio in 25% of cases 1

In terms of treatment, the goal is to achieve seizure freedom while minimizing side effects and reproductive dysfunction. Surgical intervention, such as anterior temporal lobectomy, should be considered for drug-resistant temporal lobe epilepsy, as it can provide seizure freedom in 60-80% of carefully selected patients. Other surgical options, such as laser interstitial thermal therapy or responsive neurostimulation, may also be considered. Additionally, vagus nerve stimulation may be offered when resective surgery is not possible.

Overall, the treatment of temporal lobe epilepsy requires a comprehensive approach that takes into account the potential effects of medications on reproductive function, as well as the importance of achieving seizure freedom and minimizing side effects. Regular follow-up with a neurologist is essential to monitor medication effectiveness and side effects, with blood tests needed for certain medications to check drug levels and organ function.

From the FDA Drug Label

The effectiveness of zonisamide as adjunctive therapy (added to other antiepilepsy drugs) has been established in three multicenter, placebo-controlled, double blind, 3-month clinical trials (two domestic, one European) in 499 patients with refractory partial onset seizures with or without secondary generalization Each patient had a history of at least four partial onset seizures per month in spite of receiving one or two antiepilepsy drugs at therapeutic concentrations. The primary measure of effectiveness was median percent reduction from baseline in partial seizure frequency. The results described below are for all partial seizures in the intent-to-treat populations In the first study (n = 203), all patients had a 1-month baseline observation period, then received placebo or zonisamide in one of two dose escalation regimens; Statistically significant treatment differences favoring zonisamide were seen for doses of 100,200, and 400 mg/day.

The treatment for temporal lobe epilepsy may involve the use of zonisamide as an adjunctive therapy, in addition to other antiepilepsy drugs.

• The effective doses of zonisamide for treating partial onset seizures, including those associated with temporal lobe epilepsy, were found to be 100,200, and 400 mg/day.
• Zonisamide has been shown to be effective in reducing the frequency of partial onset seizures, including those with secondary generalization.
• The primary measure of effectiveness was the median percent reduction from baseline in partial seizure frequency.
• It is essential to note that zonisamide should be used under the guidance of a healthcare professional, and the dosage may need to be adjusted based on individual patient needs and response to treatment 2.

From the Research

Treatment Options for Temporal Lobe Epilepsy

The treatment for temporal lobe epilepsy can involve various approaches, including medication and surgery.

• Antiepileptic drug (AED) treatment is a common approach, with studies suggesting that monotherapy can be effective in controlling seizures 3, 4.
• A study published in 1992 found that patients undergoing temporal lobectomy can be safely treated with carbamazepine monotherapy, with no significant differences in seizure recurrence rate compared to polytherapy 3.
• Another study published in 2012 found that topiramate monotherapy can effectively reduce seizure frequency in patients with temporal lobe epilepsy, with 28 out of 41 patients achieving seizure freedom 4.

Surgical Interventions

Surgical interventions, such as temporal lobectomy, can also be an effective treatment option for temporal lobe epilepsy.

• A systematic review published in 2011 found that surgery can be an effective treatment for drug-resistant temporal lobe epilepsy, with lesionectomy, temporal lobectomy, and vagus nerve stimulation as adjunctive therapy being considered 5.
• Another systematic review published in 2009 also found that surgery can be an effective treatment option for people with drug-resistant temporal lobe epilepsy, with temporal lobectomy being a commonly considered procedure 6.

Efficacy and Limitations of Monotherapy

The efficacy and limitations of antiepileptic drug monotherapy for temporal lobe epilepsy have been evaluated in several studies.

• A study published in 1992 found that monotherapy can be effective in controlling seizures in patients with temporal lobe epilepsy, with 44% of patients achieving effective control 7.
• The study also found that the average number of AEDs used was reduced over time, from 3.0 at the time of initial diagnosis to 1.6 in the final period 7.