Temporal Lobe Seizure

Aka: Temporal Lobe Seizure, Temporal Lobe Epilepsy, Psychomotor Seizure

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II. Epidemiology

  1. Most common complex Seizure

III. Pathophysiology

  1. Starts in Temporal Lobe
  2. Frontal Lobe commonly involved

IV. Symptoms

  1. Complex and variable
  2. Aura may be present
    1. Gastrointestinal symptoms
    2. Fear

V. Signs

  1. Motionless stare heralds Seizure
  2. Consciousness is always impaired
  3. Automatisms
  4. Oral facial moves
  5. Fumbling or picking movements
  6. Duration: 30 seconds to 2 minutes
  7. May progress to Generalized Tonic Clonic Seizure

VI. Differential diagnosis

  1. Absence Seizure (typical or atypical)
  2. Behavioral disturbance
  3. Migraine Headache

VII. Management

  1. Medications (60-70% response rate)
    1. Carbamazepine (Tegretol)
    2. Phenytoin (Dilantin)
  2. Surgery: Temporal Lobe Resection
    1. Indicated for failed medical therapy after 1-2 years
    2. Efficacy
      1. Better TLE Seizure control than with anticonvulsant
      2. Wiebe (2001) N Engl J Med 345:311-8 [PubMed]

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