A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure. Neuronal loss on the right is more prominent in non-verbal (visuospatial memory loss). In interictal periods, conversely, perfusion is reduced . SPECT and PET imaging are also a useful adjuncts, with both ictal and interictal scans demonstrating abnormalities: Other causes of temporal lobe epilepsy (TLE) should be considered, especially as small temporal lobe cortical tumours can have similar appearances. Vilayanur S. Ramachandran explored the neural basis of the hyperreligiosity seen in TLE using the galvanic skin response (GSR), which correlates with emotional arousal, to determine whether the hyperreligiosity seen in TLE was due to an overall heightened emotional state or was specific to religious stimuli. 28-year-old male with a long-standing history of seizures localizing to the inferomedial right temporal lobe on EEG. Dysphoric or euphoric feelings, fear, anger, and other emotions may also occur. These were previously known as grand mal seizures. , The temporal lobe and particularly the hippocampus play an important role in memory processing. There are 3 specific patterns of cell loss; Cell loss might involve sectors CA1 and CA4, CA4 alone, or CA1 to CA4 . , Seizures which begin in the temporal lobe, and then spread to involve both sides of the brain are termed focal to bilateral. . TLE is the most common form of epilepsy with focal seizures. Psychiatric conditions with psychotic spectrum symptoms might be more plausible physical explanation of these experiences. Figure 1: A. Coronal T2 weighted, B. Coronal FLAIR. Personality and behavioural change in temporal lobe epilepsy is seen as a chronic condition when it persists for more than three months. Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality. They project into the hilus of the dentate gyrus and stratum lucidum in the CA3 region giving inputs to both excitatory and inhibitory neurons. Age at onset Late childhood or adolescence. For patients with medial TLE whose seizures remain uncontrolled after trials of several types of anticonvulsants (that is, the epilepsy is intractable), surgical excision of the affected temporal lobe may be considered. , The International League Against Epilepsy (ILAE) recognizes two main types of temporal lobe epilepsy: mesial temporal lobe epilepsy (MTLE), arising in the hippocampus, the parahippocampal gyrus and the amygdala which are located in the inner (medial) aspect of the temporal lobe and lateral temporal lobe epilepsy (LTLE), the rarer type, arising in the neocortex at the outer (lateral) surface of the temporal lobe. Learn more from the Epilepsy Foundation. , In 2016, a case history found that a male temporal lobe epileptic patient experienced a vision of God following a temporal lobe seizure, while undergoing EEG monitoring. , The causes of TLE include mesial temporal sclerosis, traumatic brain injury, brain infections, such as encephalitis and meningitis, hypoxic brain injury, stroke, cerebral tumours, and genetic syndromes. , In certain patients with temporal lobe epilepsy it has been found that the subiculum could generate epileptic activity. , After childhood onset, one third will "grow out" of TLE, finding a lasting remission up to an average of 20 years. Most patients present with complex partial temporal lobe epilepsy. The hippocampal formation is not uniformly affected, with the dentate gyrus, and the CA1, CA4 and to a lesser degree CA3 sections of the hippocampus being primarily involved .  There is also damage to mossy cells and inhibitory interneurons in the hilar region of the hippocampus (region IV) and to the granule cells of the dentate gyrus.  In temporal lobe epilepsy, a focal seizure usually causes abnormal sensations only. , The existence of a "temporal lobe epileptic personality" and of Geschwind syndrome have been disputed and research is inconclusive. Often mentioned, but probably one of the least specific findings, is enlargement of the temporal horn of the lateral ventricle . Others have questioned the evidence for a link between temporal lobe epilepsy and religiosity. Though they may not seem harmful, due to the fact that the individual does not normally seize, they can be extremely harmful if the individual is left alone around dangerous objects. It is not uncommon for an individual to be tired or confused for up to 15 minutes after a seizure has occurred, although postictal confusion can last for hours or even days. , In TLE, granule cells are lost, the structure is no longer closely packed and there are changes in the orientation of dendrites. Stereotact Funct Neurosurg. , These seizures tend to have a warning or aura before they occur, and when they occur they generally tend to last only 1–2 minutes. Mesial temporal sclerosis in a cohort of children with SCN1A gene mutation. Mesial temporal lobe epilepsy is the most common of the medically refractory chronic epilepsies. , Temporal lobe surgery can be complicated by decreased cognitive function. , In TLE, there is loss of neurons in region CA1 and CA3 of the hippocampus. In animal models, neuronal loss occurs during seizures but in humans, neuronal loss predates the first seizure and does not necessarily continue with seizure activity. Study population An Rarely MTS can be detected in children during the first decade of life, but is not commonly found until adolescence. mesial temporal sclerosis, the types of imaging tech-niques used to diagnosis this entity, and the possible significance of secondary MR findings. Epub 2012 Apr 24 doi: 10.1177/0883073811435325.  People who experience only focal aware seizures may not recognize what they are, nor seek medical care. These impulses modulate the brain’s circuitry. , A study in 2015, reported that intrinsic religiosity and religiosity outside of organized religion were higher in patients with epilepsy than in controls.  These changes may or may not be epileptogenic. Coronal volume and coronal high resolution T2WI/FLAIR are best to diagnose MTS. The mesial temporal lobe, also known as the medial temporal lobe, is, as the name suggests, located on the medial aspect of the temporal lobe and is distinct from the rest of the lobe, which is composed of neocortex. It is seen in up to 65% of autopsy studies, although significantly less on imaging. It has been found that GABA reversal potential is depolarising in the subpopulation of the pyramidal cells due to the lack of KCC2 co-transporter. This was noted in human tissue in 1974 and in animal models in 1985. In children with newly diagnosed epilepsy, only approximately 1% have evidence of MTS on imaging. The relationship, if any, of mesial temporal sclerosis with febrile seizures is controversial, made all the more difficult due to the relative insensitivity of imaging and the difficulty in establishing whether a particular seizure was truly febrile.  The purported link between TLE and religiosity has inspired work by Michael Persinger and other researchers in the field of neurotheology. However, it was not until 2001 that a scientifically sound study was carried out to examine the effectiveness of temporal lobectomy. Mesial temporal sclerosis is the most frequent cause of drug-resistant temporal lobe epilepsy but has a satisfactory response to surgery, and is considered infrequent in children. Felbamate and vigabatrin are newer, but can have serious adverse effects so they are not considered as first-line treatments. MRI is the modality of choice to evaluate the hippocampus, however dedicated TLE protocol needs to be performed if good sensitivity and specificity is to be achieved . (1998) Personality disorders. Anterior temporal lobectomy is successful in 75-90% of patients with MTS. Olfactory hallucinations often seem indescribable to patients beyond "pleasant" or "unpleasant". Another treatment option is electrical stimulation of the brain through an implanted device called the vagus nerve stimulator (VNS). The diagnosis of temporal lobe epilepsy can include the following methods: Magnetic resonance imaging (MRI), CT scans, positron emission tomography (PET), EEG, and magnetoencephalography. Simple focal seizures are the initial non-febrile seizures followed by (ed.  Focal seizures account for approximately sixty percent of all adult cases. abnormal morphology: loss of internal architecture (interdigitations of hippocampus), increased signal and or atrophy of the anterior thalamic nucleus, increased signal and/or reduction in the volume of the, dilatation of temporal horn and temporal lobe atrophy, collateral white matter and entorhinal cortex atrophy, loss of grey-white matter interface in the anterior temporal lobe, decreased NAA and decreased NAA/Cho and NAA/Cr ratios, decreased MI in ipsilateral temporal lobe, increased lipid and lactate soon after as seizure. Pedley (Eds. , Over forty types of epilepsy are recognized and these are divided into two main groups: focal seizures and generalized seizures. Sex Males = females. It has been suggested that Pope Pius IX's doctrine of the immaculate conception was influenced by his forensically-diagnosed partial epilepsy. This is evident in intracellular recordings.  Lower education level, abnormal background EEG activity, and hippocampal sclerosis have been found to be contributing factors for religiosity in TLE. There is some period of recovery in which neurological function is altered after each of these seizure types. The relationship, if any, of mesial temporal sclerosis with febrile seizures is controversial, made all the more difficult due to the relative insensitivity of imaging and the difficulty in establishing whether a particular seizure was truly febrile. (p416–431), Aberrant mossy fibre sprouting may create excitatory feedback circuits that lead to temporal lobe seizures. Animal models and clinical studies show that memory loss correlates with temporal lobe neuronal loss in temporal lobe epilepsy. , Granule cell dispersion is a type of developmental migration and a pathological change found in the TLE brain which was first described in 1990. This study was presented as an abstract at a neuroscience conference and referenced in Ramachandran's book, Phantoms in the Brain, but it has never been published in the peer-reviewed scientific press. With this type, some people do not even realize they are having a seizure and most of the time their memory from right before or after the seizure is wiped. Conversely, due to neuronal dysfunction and swelling, diffusion is restricted following a seizure, and thus values are lower . In 1981, the ILAE recognized three types of seizures occurring in temporal lobe epilepsy. Documented by Norman Geschwind, signs include: hypergraphia (compulsion to write (or draw) excessively), hyperreligiosity (intense religious or philosophical experiences or interests), hyposexuality (reduced sexual interest or drive), circumstantiality (result of a non-linear thought pattern, talks at length about irrelevant and trivial details). A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure. Van Poppel K, Patay Z, Roberts D, Clarke DF, McGregor A, Perkins FF, Wheless JW J Child Neurol 2012 Jul;27(7):893-7. Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a group of chronic disorders characterized by prominent neuronal loss and gliosis in the hippocampus and amygdala. Most anticonvulsants function by decreasing the excitation of neurons, for example, by blocking fast or slow sodium channels or by modulating calcium channels; or by enhancing the inhibition of neurons, for example by potentiating the effects of inhibitory neurotransmitters like GABA. Our primary outcome is time-to-seizure recurrence. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Mesial Temporal Sclerosis Electrical Stimulation of Subiculum for the Treatment of Refractory Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis: A 2-Year Follow-Up Study. Columbia Once Again Ranked Among Top Medical Schools and Hospitals by U.S. News & World Report Columbia Participates in Major NIH Stroke Prevention Trial Columbia Pediatric Neurosurgery Group Publishes Review of Sickle Cell Treatment Columbia Receives ‘Great Neurosurgery and Spine Program’ Recognition Columbia Resident Neurosurgeon, Dr. Benjamin Kennedy Sends us Greetings From Uganda! , When a seizure begins in the temporal lobe, its effects depend on the precise location of its point of origin, its locus. 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