What are the symptoms of temporal lobe epilepsy (TLE)?

From the Guidelines

Temporal lobe epilepsy (TLE) presents with distinct symptoms that vary depending on which part of the temporal lobe is affected, including auras, altered awareness, staring, automatisms, and impaired speech, as well as long-term symptoms such as memory impairment, emotional, and psychiatric symptoms. The symptoms of TLE can be complex and varied, but common symptoms include:

• Auras, which are sensations that precede a seizure, such as unusual smells, tastes, rising abdominal sensations, déjà vu, or intense fear
• Altered awareness, staring, automatisms (repetitive movements like lip smacking or hand fumbling), and impaired speech during seizures
• Confusion, memory problems, and fatigue after seizures
• Memory impairment, particularly for verbal memory with dominant hemisphere involvement, as a common long-term symptom
• Emotional and psychiatric symptoms like depression, anxiety, and personality changes that can also develop

TLE is typically diagnosed through clinical evaluation, EEG monitoring, and brain imaging (MRI) 1. Treatment usually involves antiseizure medications like carbamazepine, lamotrigine, or levetiracetam, and for medication-resistant cases, surgical intervention may be considered 1. The use of perfusion SPECT imaging, particularly ictal SPECT, has been shown to be useful in localizing the seizure onset zone in TLE, with a sensitivity of 73% and specificity of 75% 1.

The diagnosis and treatment of TLE should prioritize the patient's quality of life, morbidity, and mortality, and the most recent and highest quality studies should be considered when making treatment decisions 1. In the case of TLE, the most recent study on the topic is from 2024, which highlights the importance of using advanced imaging techniques, such as perfusion SPECT and PET, in the diagnosis and treatment of TLE 1.

Some key points to consider when diagnosing and treating TLE include:

• The importance of clinical evaluation, EEG monitoring, and brain imaging (MRI) in diagnosing TLE
• The use of antiseizure medications like carbamazepine, lamotrigine, or levetiracetam as the first line of treatment
• The consideration of surgical intervention for medication-resistant cases
• The use of advanced imaging techniques, such as perfusion SPECT and PET, in localizing the seizure onset zone and guiding treatment decisions.

From the Research

Symptoms of Temporal Lobe Epilepsy (TLE)

The symptoms of TLE can vary, but common characteristics include:

• Simple partial, complex partial, and secondarily generalized seizures 2
• An aura, most commonly an epigastric sensation that often has a rising character, reported by more than 90% of patients with mesial TLE 2
• Autonomic symptoms, psychic symptoms, and certain sensory phenomena, such as olfactory auras 2
• Motor arrest, oroalimentary automatisms, or non-specific extremity automatisms at the onset of complex partial seizures 2
• Dystonic posturing, early head turning, and adversive head turning in transition to generalization, which can have lateralizing value 2

Seizure Characteristics

• The duration of TLE complex partial seizures is generally greater than one minute 2
• Postictal confusion usually occurs 2
• Postictal aphasia can indicate left-sided lateralization 2
• Ictal vomiting, spitting, and drinking tend to be right-sided 2
• Well-formed ictal language favors right temporal localization 2

Diagnosis and Treatment

• TLE is diagnosed by a history of characteristic partial seizure symptoms and confirmed by electroencephalogram (EEG) or video-EEG 3
• Treatment options include medications, resective surgery, and vagus nerve stimulation 3
• Epilepsy surgery may be a good treatment option for patients with hippocampal sclerosis and uncontrolled seizures 4