Temporal lobe epilepsy is considered the most common form of this neurological disorder. This is due to many different factors. During the course of the disease, the focus of pathological activity is located in the temporal zone.
This pathology is characterized by the occurrence of seizures, which are gradually joined by mental disorders. To avoid complications, it is important to be examined and treated in a timely manner.
Feature of the disease
Temporal lobe epilepsy refers to a neurological pathology that is mainly accompanied by seizures. In 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.
Temporal lobe epilepsy symptoms often occur in people younger than 20 years old, and in 1/3 epileptics - up to 1 year old. In children, such attacks are additionally accompanied by an increasetemperature.
The course of the disease in children
For the first time, symptoms of temporal lobe epilepsy are detected in children under 6 years of age. These signs are mostly ignored by parents, since during the course of the disease there are no convulsions provoked by fever. Subsequently, the disease may not bother the child for several years.
As you get older, this disruption during a relapse can cause visual, auditory, and gustatory hallucinations. You may also experience goosebumps and convulsions.
Over time, accompanying violations appear. Temporal epilepsy in children provokes some complications. Children suffering from this disorder remember information much worse, cannot think abstractly, and 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 frequency of seizures. Small patients are mainly 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 speech disorders and other disorders may occur after the intervention.
Main classification
Temporal region epilepsy can be of several types, namely:
- opercular;
- amygdala;
- hippocampal;
- lateral.
The hippocampal form of the disease accounts for approximately 70-80% of all cases. Attacks can be focal, group, individual. With complex focal seizures, hallucinations can be observed. A person's gaze freezes, and there are many other accompanying signs. The attack lasts up to 2 minutes.
Amygdala form is characterized by the fact that the patient has seizures, accompanied by discomfort in the stomach, nausea, autonomic symptoms. A person during a seizure falls into a stupor, looks confused.
The lateral form of epilepsy is accompanied by visual and auditory hallucinations. A person's speech, orientation are disturbed, prolonged auditory hallucinations are observed. The patient's head moves only in one direction. Sometimes he can literally fall asleep on the go, which threatens with very dangerous consequences.
The opercular form is characterized by the appearance of hallucinations, belching, twitching of facial muscles. With this type of illness, memory deteriorates significantly, the level of conflict increases, the mood becomes unstable.
Often, patients are diagnosed with symptomatic temporal lobe epilepsy, which occurs in almost one in four suffering from such a 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 convulsions orthe presence of an isolated aura.
Types of seizures
Temporal lobe epilepsy attacks are divided into 3 main types, namely:
- simple;
- difficult;
- secondary-generalized.
Simple seizures generally occur without disturbing the patient's consciousness and often precede more complex disorders. Taste and olfactory disturbances are observed, which manifest themselves in the form of sensations of unpleasant tastes and odors. Sometimes there may be chills and arrhythmias.
Patients complain of a sense of fear, a distorted perception of objects and time. Sometimes there are visual hallucinations. This condition may be temporary or last for several days.
Complex seizures occur with a violation of the patient's consciousness and unconscious actions during the attack. 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 understand at all that he is being addressed. A complex attack lasts about 2 minutes. At the end of it, the patient does not remember what happened. In addition, he begins to suffer from a severe headache. In some cases, there is a loss of motor activity.
Secondary-generalized seizures mainly occur with a strong progression of the disease. When they occur, the patient loses consciousness and he has convulsions of all muscles.
As epilepsy progresses, it leads to complex intellectual and mentalviolations. Often, these attacks occur quite spontaneously.
Causes of occurrence
Temporal lobe epilepsy in adults and children develops under the influence of many factors and is combined into two large groups, namely: perinatal and postnatal. Among the main causes of the disease, the following should be distinguished:
- fetal asphyxia;
- preterm birth;
- dysplasia;
- intrauterine infection;
- birth trauma;
- hypoxia.
The temporal lobes of the brain are located in the area that is most exposed to maximum exposure during fetal growth and delivery. When this part of the skull is squeezed, sclerosis and ischemia of the brain tissues begin to develop. Subsequently, this can lead to the formation of an epileptic focus.
Secondary causes of temporal lobe epilepsy include the following:
- inflammation and tumors of brain tissues;
- intoxication of the body;
- excessive drinking;
- allergy;
- traumatic brain injury;
- lack of vitamins;
- high temperature;
- impaired circulation and metabolism;
- hypoglycemia.
Sometimes the signs of a disease occur for no reason at all. Doctors are not always able to identify the factors that provoked neurological disorders.
Main symptoms
Temporal lobe epilepsy symptoms can be very different, and they depend largely on the type of seizures. With simple partial seizures, the patient's consciousnessis not violated at all. Their course may be accompanied by the appearance of an unpleasant aftertaste in the mouth, and sometimes patients think that they feel an unpleasant odor. Other signs of temporal lobe epilepsy include the following:
- palpitations;
- chill;
- visual hallucinations.
The patient may not recognize his relatives and friends at all, not understand where he is. The state of detachment passes very quickly or lasts for several days.
Complex seizures mainly occur with loss of consciousness and the occurrence of automatic movements. In some cases, it seems that a person is completely he althy, but by his behavior he can harm himself and other people. He can perceive the situation around him and the events taking place 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;
- skin blanching;
- 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. It is also possible isolation, reduced sociability.
Diagnostics
Symptoms and treatmenttemporal lobe epilepsy depend on many different factors. Modern research methods have made it possible to establish with absolute certainty that the focus of excessive activity of neurons is not always formed in the temporal zone of the brain. Sometimes it gradually overflows from other areas of the brain.
Recognize the course of the disease is often quite difficult. Some of its signs are similar to the symptoms of various abnormalities. That is why one questioning of the patient and a thorough history taking is not enough. To clarify the diagnosis is assigned:
- electroencephalogram;
- MRI;
- PET.
All these techniques help to detect abnormalities occurring in the brain area, which allows you to make the correct diagnosis and prescribe treatment.
Features of treatment
The main goal of the treatment of temporal lobe epilepsy is to reduce the frequency of seizures. First of all, patients are prescribed monotherapy, which involves taking the drug "Carbamazepine". If this medicine is ineffective, then hydantoins, valproates, barbiturates are indicated. In the absence of the desired therapeutic effect, the doctor may prescribe polytherapy, which involves taking several drugs.
Surgical treatment may be prescribed if a person is unresponsive to medication. Often neurosurgeons perform temporal resection.
Drug therapy
As already mentioned, drug treatment of temporal lobe epilepsyimplies taking drugs such as Carbamzepine, Phenytoin. Therapy begins with only one drug. Initially, the doctor prescribes a minimum dosage, which then increases to 20 mg per day, and in some cases up to 30 mg.
If the patient's he alth does not improve, then it is possible to increase the dosage until the therapeutic results improve or the appearance of pronounced signs of intoxication. In especially difficult cases and in the presence of secondary generalized seizures, the drug "Depakine" or "Difenin" is prescribed.
Polytherapy is used only if taking only one drug did not bring 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 "Difenin". However, it is worth remembering that this combination has an inhibitory effect on the nervous system, leads to memory impairment, and also has a negative effect on 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 the attacks, the most important thing is to choose the right medicine.
Surgery
If drug therapy does not bring the desired result, the doctor prescribes an operation for the treatment of temporal lobe epilepsy, she deserves rather mixed reviews. Some experts claimthat this is a fairly effective tool that helps to 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 decision regarding the operation should be made by the doctor, if there are serious indications.
It is not recommended to resort to surgical treatment if the patient has a serious condition, a severe impairment of the intellect and psyche. Constant medical supervision is required.
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 regions of the temporal region of the brain.
Possible Complications
Structural temporal lobe epilepsy is very dangerous for its complications, which should be attributed to:
- convulsive seizures;
- vegetovascular dystonia;
- traumatic injury during an attack.
Seizures can recur quite often, which causes many different problems. In this case, the person may lose consciousness. The patient needs urgent help, as during an attack, serious violations occur in the respiratory and cardiovascular systems, 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 seizures do not bother for a long timehuman, 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 to minimize the frequency of seizures and allow epileptics to live a normal life. According to patients, in order to maintain a stable normal state, it is necessary to strictly follow all the prescriptions and recommendations of doctors, take medications in a timely and systematic manner and exclude factors that contribute to the recurrence of seizures.
Epilepsy can begin at a very early age, even in infants or adults after 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, medication reduces the frequency of seizures.
After the operation, complete recovery is observed in approximately 30-50% of all cases. In the rest, epileptic seizures are observed much less frequently.
Prevention measures
Temporal epilepsy prevention is divided into primary and secondary. Primary is aimed at eliminating the causes that can provoke the onset of the disease. It includes careful, constant monitoring of the well-being of a woman during gestation, as well as:
- prevention of intrauterine hypoxia, intrauterine infections;
- rational delivery.
Secondary preventioncarried out in those who have already been diagnosed with the disease. It is aimed at preventing the frequent occurrence of seizures. Epileptics must strictly observe the regimen of taking medications, engage in therapeutic exercises, and strictly adhere to the daily routine.
They need to do everything possible to avoid exposure to various pathogens that lead to increased convulsive brain activity, such as listening to very loud music.
With timely access to the doctor and proper treatment, patients manage to completely cope with attacks or make them more rare. It is important to be very attentive to the recommendations of a specialist, as preventive measures can avoid the frequent occurrence of seizures.
