Temporal epilepsy is considered the most common form of this neurological disorder. This is due to many different factors. With the course of the disease, the focus of pathological activity is in the temporal zone.
For this pathology, the occurrence of seizures is characteristic, to which mental disorders gradually join. To avoid complications, it is important to be examined in a timely manner and undergo a course of treatment.
Disease feature
Temporal epilepsy refers to a neurological pathology, which is mainly accompanied by seizures. At the initial stages, the disease manifests itself in the form of partial seizures, which are characterized by the preservation of the patient's consciousness. With a longer progression of the disease, a person completely loses touch with reality during the next seizure.
Often, symptoms of temporal lobe epilepsy occur in people younger than 20 years old, and in 1/3 of epileptics - up to 1 year. In children, such attacks are additionally accompanied by fever.
The course of the disease in children
For the first time, symptoms of temporal lobe epilepsy are detected in children under 6 years old. These signs are mainly left without parental attention, since during the course of the disease convulsions do not occur, provoked by an increase in temperature. Subsequently, the disease may not bother the child for several years.
As they grow older, such a violation during the course of a relapse can cause visual, auditory and taste hallucinations. It may also cause goosebumps and convulsions.
Over time, concomitant violations appear. Temporal epilepsy in children provokes some complications. Children suffering from this disorder remember information much worse, cannot think abstractly, are emotionally unstable. In adolescents, the presence of epileptic foci negatively affects puberty.
Therapy for temporal lobe epilepsy in children is aimed at reducing the incidence of seizures. Small patients are usually prescribed monotherapy. If it does not bring the desired result, then the doctor selects several drugs that are combined with each other.
If the disease does not respond well to drug therapy, doctors decide on the operation. However, it is worth remembering that after the intervention, speech disorders and other disorders can occur.
Main classification
Temporal lobe epilepsy can be of several types, namely:
- opercular;
- amygdala;
- hippocampal;
- lateral.
The hippocampal form of the disease is approximately 70-80% of all cases. Attacks can be focal, group, individual. With complex focal seizures, hallucinations can be observed. A person freezes his eyes, and also there are many other related symptoms. The attack lasts up to 2 minutes.
The amygdala form is characterized by the fact that the patient has seizures, accompanied by discomfort in the stomach, nausea, and vegetative signs. A person during a seizure falls into a stupor, looks confused.
The lateral form of epilepsy is accompanied by visual and auditory hallucinations. In humans, speech and orientation are disturbed, prolonged auditory hallucinations are observed. The patient’s head moves only in one direction. Sometimes he literally on the go can fall asleep, which threatens very dangerous consequences.
The appearance of a hallucination, belching, twitching of the muscles of the face is characteristic of the opercular form. With this type of disease, memory worsens significantly, the level of conflict increases, the mood becomes unstable.
Often, patients are diagnosed with symptomatic temporal lobe epilepsy, which occurs in almost every fourth person suffering from a similar disorder. A similar problem is caused by brain injuries, vascular or other concomitant diseases. It is especially common in children. At the same time, the onset of the course of the disease remains completely unnoticed, as it manifests itself in the form of a cramp or the presence of an isolated aura.
Types of Attacks
Attacks of temporal lobe epilepsy are divided into 3 main varieties, namely:
- simple;
- complex
- secondary generalized.
Simple attacks generally occur without impairing the patient’s consciousness and often precede more complex disorders. Taste and olfactory disturbances are observed, which manifest themselves in the form of a sensation of unpleasant tastes and smells. Sometimes there may be chills and arrhythmia.
Patients complain of a sense of fear, a distorted perception of objects and time. Visual hallucinations are sometimes present. This condition may be temporary or may last several days.
Complex attacks occur with impaired patient consciousness and unconscious actions during the attack period. Often you can observe constant chewing movements, frequent swallowing, mumbling.
Automatisms are more like conscious movements, which can be quite dangerous. During this period, a person may not at all understand what is being addressed to him. A complex attack lasts about 2 minutes. At its end, the patient does not remember what happened. In addition, a severe headache begins to torment him. In some cases, there is a loss of motor activity.
Secondary generalized seizures occur mainly with a strong progression of the disease. When they flow, the patient loses consciousness and he has cramps of all muscles.
With progression, epilepsy leads to complex intellectual and mental disorders. Often such attacks occur completely spontaneously.
Causes of occurrence
Temporal epilepsy in adults and children develops under the influence of many factors and combines into two large groups, namely: perinatal and postnatal. Among the main causes of the disease, it is necessary to highlight the following:
- fetal asphyxiation;
- premature birth;
- dysplasia;
- intrauterine infection;
- birth injuries;
- hypoxia.
The temporal lobes of the brain are located in the area that is most susceptible to maximum exposure during fetal growth and during delivery. When this part of the skull is crushed, sclerosis and ischemia of brain tissue begins to develop. Subsequently, this can lead to the formation of an epileptic focus.
The secondary causes of temporal lobe epilepsy include the following:
- inflammation and tumors of brain tissue;
- intoxication of the body;
- excessive consumption of alcohol;
- allergies
- head injuries;
- lack of vitamins;
- high temperature
- circulatory and metabolic disorders;
- hypoglycemia.
Sometimes signs of the course of the disease occur completely without reason. Doctors are not always able to identify factors that triggered neurological disorders.
Main symptoms
Symptoms of temporal lobe epilepsy can be very different, and they depend largely on the type of seizure. With simple partial seizures , the patient’s consciousness is not completely disturbed. Their course can be accompanied by the appearance of an unpleasant aftertaste in the mouth, and sometimes it seems to patients that they feel an unpleasant odor. Other signs of temporal lobe epilepsy include the following:
- heart palpitations;
- chills;
- visual hallucinations.
The patient may not at all recognize his family and friends, not understand where he is. The state of detachment passes very quickly or continues for several days.
Complicated seizures occur mainly with loss of consciousness and the occurrence of automatic movements. In some cases, it seems that a person is completely healthy, but by his behavior he can harm himself and other people. He can perceive the situation around himself and current events as what happened to him in the past.
At the initial stage of development, the diagnosis of epilepsy is rather difficult because the clinical picture has no characteristic signs. Before or during an attack, symptoms of temporal lobe epilepsy are observed, such as:
- excessive sweating;
- heartburn;
- blanching of the skin;
- nausea;
- abdominal pain;
- feeling of lack of air;
- arrhythmia.
In advanced cases, the disease can provoke a change in the psyche, in connection with which a person becomes suspicious, forgetful, aggressive. Closure and a decrease in sociability are also possible.
Diagnostics
Symptoms and treatment of temporal lobe epilepsy depend on many different factors. Modern research methods have made it absolutely possible to establish that the focus of excessive activity of neurons is far from always formed in the temporal zone of the brain. Sometimes it gradually flows from other areas of the brain.
Recognizing the course of the disease is often quite difficult. Certain signs are similar to the symptoms of various deviations. That is why one patient survey and a thorough history taking is not enough. To clarify the diagnosis assigned:
- electroencephalogram;
- MRI
- PAT.
All these techniques help to detect abnormalities that occur in the area of the brain, which allows you to make the correct diagnosis and prescribe treatment.
Treatment features
The primary goal of treating temporal lobe epilepsy is to reduce the incidence of seizures. First of all, patients are prescribed monotherapy, which involves taking the drug "Carbamazepine". If this medicine is ineffective, then the use of hydantoins, valproates, barbiturates is indicated. In the absence of the required therapeutic effect, the doctor may prescribe polytherapy, which involves taking several drugs.
If a person is immune to medications, surgical treatment can be prescribed. Often, neurosurgeons perform a temporal resection.
Drug therapy
As already mentioned, drug treatment of temporal lobe epilepsy involves taking drugs such as Carbamzepine, Phenytoin. Therapy begins with only one drug. Initially, the doctor prescribes the minimum dosage, which then rises to 20 mg per day, and in some cases up to 30 mg.
If the patient's well-being does not improve, then it is possible to increase the dosage until the therapeutic results improve or pronounced signs of intoxication occur. In especially difficult cases and in the presence of secondary-generalized seizures, the drug Depakin or Difenin is prescribed.
Polytherapy is used only if taking only one drug has not brought the desired result. Multiple combinations of reserve and basic antiepileptic drugs are possible. A decrease in the number of seizures is observed mainly when taking "Phenobarbital" along with "Diphenin." However, it is worth remembering that this combination has a inhibitory effect on the nervous system, leads to memory impairment, and also negatively affects the digestive organs.
Drug therapy necessarily requires lifelong medication and careful monitoring by doctors. In about half of all cases of the course of the disease, it is possible to completely get rid of attacks, the most important thing is to choose the right medicine.
Surgical intervention
If drug therapy does not bring the required result, the doctor prescribes an operation for the treatment of temporal lobe epilepsy, the reviews she deserved are rather mixed. Some experts argue that this is a fairly effective tool that helps get rid of the existing problem. But others draw attention to the fact that such a radical technique can provoke many complications. That is why the doctor should decide on the operation if there is a serious indication.
It is not recommended to resort to surgical treatment if the patient is in serious condition, severely impaired intelligence and psyche. Necessarily requires constant medical supervision.
During the operation, the neurosurgeon eliminates the epileptogenic focus and prevents the spread of epileptic impulses. To do this, the doctor performs a temporal lobectomy, and then removes the anterior and mediobasal parts of the temporal region of the brain.
Possible complications
Structural temporal lobe epilepsy is very dangerous for its complications, which include:
- convulsive attacks;
- vegetovascular dystonia;
- traumatic damage during an attack.
Convulsive seizures can be repeated quite often, which causes many different problems. In this case, a person may lose consciousness. The patient needs urgent care, since during an attack there are serious disorders in the respiratory and cardiovascular system, which sometimes leads to the death of the patient.
Forecast
The prognosis of temporal lobe epilepsy depends on many different factors. This is a disease that is completely impossible to get rid of. Even if the attacks do not bother the person for a long time, there is always a risk of their occurrence. They can occur at any time under the influence of various negative factors.
However, modern techniques help minimize the frequency of seizures and allow epileptics to live a normal life. According to patients' reviews, in order to maintain a stable normal state, one must very strictly observe all the prescriptions and recommendations of doctors, take medications in a timely and systematic manner and exclude factors contributing to the recurrence of seizures.
Epilepsy can begin even at a very young age, even in infants or in adults after a traumatic brain injury. Timely treatment allows you to successfully fight this disease, control seizures or even completely stop them. A positive outcome of drug therapy is observed in approximately 35% of all cases. Usually, after taking medication, it is possible to reduce the frequency of seizures.
After the operation, complete recovery is observed in approximately 30-50% of all cases. In others, epileptic seizures are much less common.
Preventive measures
Prevention of the temporal form of epilepsy is divided into primary and secondary. The primary goal is to eliminate the causes that can trigger the onset of the disease. It includes careful, constant monitoring of the woman's well-being during gestation, as well as:
- prevention of intrauterine hypoxia, intrauterine infections;
- rational delivery.
Secondary prevention is carried out in those who have already been diagnosed with the disease. It aims to prevent the frequent occurrence of seizures. Epileptics must strictly adhere to the regimen of taking medications, do therapeutic exercises, and also strictly adhere to the daily regimen.
They need to completely avoid the effects of various pathogens, which lead to an increase in convulsive brain activity, for example, such as listening to very loud music.
With timely access to a doctor and properly conducted treatment, patients manage to completely cope with seizures or make them more rare. It is important to be very attentive to the recommendations of a specialist, since preventive measures help to avoid the frequent occurrence of seizures.