What is temporal lobe epilepsy
Temporal lobe epilepsy
Synonyms: temporal lobe epilepsy, psychomotor epilepsy
English: temporal lobe epilepsy
The Temporal lobe epilepsy, short TLE, is a focal form of epilepsy belonging to the epilepsy syndromes, the focus of which is localized in the temporal lobe.
ICD code 40.2
Temporal lobe epilepsy is the most common form of epilepsy in children and adults with first manifestations between the ages of 5 and 10.
Depending on the focus localization, a distinction is made between mesial and neocortical TLE:
- Mesial temporal lobe epilepsy (mTLE): The most common form of temporal lobe epilepsy. The epileptic focus lies in the hippocampus or in areas near the hippocampus (area entorhinalis, amygdala).
- Neocortical or Lateral Temporal Lobe Epilepsy (nTLE / ITLE): The focus is localized in the temporal neocortex.
Cryptogenic forms with an unclear cause are about as common as organic brain lesions, e.g.
The seizure characteristics are individual and different depending on the form:
5.1 Mesial temporal lobe epilepsy
In mesial temporal lobe epilepsy, febrile seizures can occur as prodromes in childhood before the first onset of the seizures. The time interval can be several years.
In over 80% of patients, the seizure begins with an aura, followed by a stare, early oral automatisms, contralateral toning combined with vegetative symptoms, and impaired consciousness. Postictal patients often have a long reorientation phase. The duration of such attacks is usually 1-3 minutes and repeats weekly to monthly.
5.2 Neocortical temporal lobe epilepsy
Neocortical temporal lobe epilepsy usually manifests itself early in the presence of disorders of the cerebral cortex, but later in the case of vascular or neoplastic causes and neurodegenerative diseases. Patients often experience an aura with auditory hallucinations (noises, voices), illusions and complex visual phenomena (micropsia, macropsia). There may be language arrest and early contralateral toning.
The EEG or long-term EEG shows uni- or bitemporal spikes and sharp waves typical of epilepsy. The further clarification of the cause is carried out by means of imaging procedures (MRT, CCT).
7.1 Drug therapy
The choice of anticonvulsant should always be patient-oriented and with as few side effects as possible. First choice drugs include:
The second choice agents are carbamazepine, oxcarbazepine, topiramate, valproate, gabapentin and pregabalin.
7.2 Operative therapy
If at least two anti-epileptic drugs used in the maximum tolerated dose are unsuccessful or after 5 years of unsuccessful drug therapy at the latest, the patient should be referred to a special epilepsy surgical center to check the operability of the seizure disorder.
The surgical procedures require complex pre-surgical epilepsy diagnostics. In addition to the focus localization, it is checked whether the identified seizure-generating structure can be removed without additional neurological and neuropsychological defects.
A distinction is made in surgical therapy between:
In about 30-40% of patients with temporal lobe epilepsy, drug therapy alone does not lead to adequate control of seizures. The results of epilepsy surgery are better, but the therapy is associated with higher risks. Freedom from seizures can be achieved in over 60% of patients with treatment in a specialized center (with continued anti-epileptic treatment).
- S1 guideline for diagnostics and therapy in neurology: First epileptic seizures and epilepsies in adulthood (2017)  last accessed on December 7, 2020
- Neurologieetz  last accessed on December 7th, 2020
- Hufschmidt et al .: Neurology Compact. 8th edition. Thieme publishing house.
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