From the Guidelines
Temporal Lobe Seizure Symptoms with Focal Impaired Awareness (FIA)
The symptoms of a temporal lobe seizure with focal impaired awareness (FIA) include staring spells, with or without changes in consciousness, and can also present with abnormal facial movements or small repetitive movements 1.
- These seizures affect only one area of the brain and can manifest as jerking of only one extremity or one side of the body.
- Urinary incontinence may also occur during a seizure.
- Seizure duration can range from seconds to hours, and most seizures are followed by a postictal period in which the person appears tired and confused for several minutes 1.
Diagnostic Imaging
- MRI is an important tool for determining prognosis as well as a treatment strategy, and is the imaging study of choice when indicated 1.
- Ictal SPECT imaging can measure the regional cerebral blood flow associated with epileptic seizures and has a higher performance in detection of epileptic networks in temporal lobe epilepsy (TLE) compared to extra-temporal lobe epilepsy (ETLE) 1.
- SISCOM (subtraction of ictal and inter-ictal SPECT co-registered to MRI) can improve the sensitivity and specificity of seizure-related perfusion networks and has been shown to be useful in mesial temporal lobe epilepsy with hippocampal sclerosis 1.
From the Research
Symptoms of Temporal Lobe Seizure with Focal Impaired Awareness (FIA)
- The symptoms of temporal lobe seizures with focal impaired awareness (FIA) can include psychopathology, such as behavioral and affective symptoms 2.
- Geriatric presentations can often be subtle and go unnoticed, aside from a few symptoms, such as confusion and memory lapses 2.
- Impaired consciousness in temporal lobe seizures can be associated with altered cortical function, including bilateral frontoparietal slow wave activity on intracranial electroencephalography 3.
- Disrupted alertness and related functional connectivity in patients with focal impaired awareness seizures in temporal lobe epilepsy can also occur, including impaired tonic and phasic alertness 4.
- In some cases, temporal lobe seizures can produce loss of wakefulness without ictal asystole, although this is an exceptional phenomenon 5.
- The symptoms of FIA can also include transient psychosis, as presented in a unique case of a geriatric patient with FIAS presenting as transient psychosis 2.
- Alteration of awareness is a main feature of focal epileptic seizures, and can be related to loss of signal complexity and information processing 6.