Temporal Lobe Epilepsy

What is temporal lobe epilepsy (TLE)?

Temporal lobe epilepsy (TLE) is the most common seizure disorder, affecting an estimated 50 million people worldwide. start in the brain’s temporal lobe. This area is located on each side of your brain, extending from your eye to just behind the ears.

Temporal lobe seizures are a type of focal seizure, which means they start in one area of the brain. In some cases, focal seizures can spread to both sides of the brain and become generalized seizures.

Temporal lobe epilepsy is the most common type of focal epilepsy in children and adults.

As a Level 4 Epilepsy Center, certified by the National Association of Epilepsy Centers, Massachusetts General Hospital provides the highest level of epilepsy care available. Our team provides advanced neurodiagnostic monitoring, along with comprehensive medical, neuropsychological, and psychosocial treatment for even the most complex cases. We also offer full evaluations for epilepsy surgery, including intracranial monitoring and specialized surgical procedures that are not widely available at other institutions.

The Pediatric Epilepsy Program at Mass General for Children provides advanced diagnostic tests and treatments for epilepsy conditions that cause seizures in children.

Is temporal lobe epilepsy always progressive?

Mesial temporal lobe epilepsy (MTLE) is often a progressive disease, meaning seizures can become more frequent or severe over time. Still, about three in four people with MTLE are able to control temporal lobe seizures with medications.

What are the symptoms of temporal lobe epilepsy seizures?

Temporal lobe epilepsy causes focal seizures in one area of the brain, but these can also progress to become bigger seizures. Temporal lobe epilepsy symptoms vary depending on the type of seizure.

Symptoms of focal aware seizures

Focal aware seizures occur while you’re alert and conscious and often last less than five minutes. They typically start with an aura—a warning sign that can feel like déjà vu.

Other signs of focal onset seizures (also called simple partial seizures) include, but are not limited to:

• Feelings of joy or fear
• Shaking
• Sudden nausea
• Unusual sensations, smells, or visions

Symptoms of focal impaired awareness seizures

Focal impaired awareness seizures (also called complex partial seizures) can last a few minutes. You aren’t aware you’re having a seizure and won’t remember it afterward. You may feel dazed or confused.

These seizures may cause abnormal movements, such as:

• Freezing up and staring
• Laughing, crying, screaming, or repeating words that are gibberish
• Picking at clothes or the air
• Smacking lips or moving your mouth

Symptoms of a focal to bilateral tonic-clonic seizure

Focal onset aware seizures and focal impaired awareness seizures can progress and affect both sides of the brain. When this occurs, you have a focal to bilateral tonic-clonic seizure.

A tonic-clonic seizure causes:

• Tonic movements: Limb stiffening and loss of consciousness
• Clonic movements: Rhythmic jerking and convulsions

People who have tonic-clonic seizures may also experience personality changes after the seizure ends, such as impulsive or socially inappropriate behaviors.

Causes of temporal lobe epilepsy

Abnormal electrical activity in the temporal lobe of the brain causes temporal lobe seizures. An injury or damage to the brain can cause this abnormal brain activity, but sometimes we do not know the cause. This brain injury may be due to:

• Scarring in the temporal lobe’s hippocampus (gliosis)
• Brain infection, such as encephalitis or meningitis
• Brain tumor
• Genetic syndromes
• Stroke
• Substance use disorders and withdrawal
• Traumatic brain injury
• Vascular malformations

Risk factors for temporal lobe epilepsy

The most common risk factor for temporal lobe epilepsy is a history of prolonged febrile seizures (seizures that occur with a high fever during early childhood). However, most children with febrile seizures don’t develop temporal lobe epilepsy.

Types of temporal lobe epilepsy

Temporal lobe epilepsy can affect either the right or left temporal lobe of the brain, depending on where the seizures begin. Right temporal lobe epilepsy refers to seizures that start in the right temporal lobe. Left temporal lobe epilepsy seizures start in the left temporal lobe.

There are different types of temporal lobe epilepsy:

• Mesial temporal lobe epilepsy (MTLE): Mesial means middle. MTLE seizures start in or near the hippocampus, which is in the inner part of each temporal lobe (closest to the center of the brain). The hippocampus is key to memory and learning. MTLE is the most common type of temporal lobe epilepsy.

• Neocortical or lateral temporal lobe epilepsy: Temporal lobe seizures start in the outer part of the temporal lobe.

Learn more about epilepsy symptoms, diagnosis, and treatments from a Mass General Brigham epilepsy specialist.

Diagnosis of temporal lobe epilepsy

To diagnose temporal lobe epilepsy, your doctor will review your symptoms and perform a neurological examination. You may also get these tests:

• Electroencephalogram (EEG): This test detects electrical activity and changes in the brain that cause temporal lobe seizures. It can help determine if seizures start in the temporal lobe.
• MRI: This brain imaging test detects structural changes in the brain, such as scarring.

Treatment of temporal lobe epilepsy

Treatments for temporal lobe seizures depend on the type of seizures, how often they happen, and how they affect your daily life. However, the most common treatments include anti-seizure medications.

Your doctor will work with you to find the best plan based on your needs. Call the Epilepsy Center at 617-726-3311 to schedule an appointment.

Anti-seizure medications

Medications that prevent seizures or reduce how often they occur are often the first line of treatment for temporal lobe seizures.

There are many medications for temporal lobe seizures. Your doctor will work with you to find the most effective option with the fewest side effects. You may need a combination of medications at different dosages.

About 1/3 of people with temporal lobe epilepsy don’t respond to medications. This is known as drug-resistant epilepsy.

Epilepsy surgery

People who have drug-resistant temporal lobe epilepsy may benefit from surgery. A temporal lobectomy involves surgically removing the part of the temporal lobe where seizures originate. This surgery can be highly effective—as many as 7 in 10 people are seizure-free after surgery.

Because the temporal lobe is key for memory and language, it’s important to have surgery performed by an experienced epilepsy team to minimize risks and preserve brain function. When it was established, the Mass General Epilepsy Center was one of the nation's first clinics to focus exclusively on patients suffering seizures.

Neuromodulation therapy

Neuromodulation therapy uses implantable devices to deliver small, safe electric currents to your nerves or brain. It stops epileptic seizures by changing how brain cells work. Your doctor may recommend neuromodulation therapy if seizure medications don’t help and surgery isn’t an option.

Neuromodulation therapies for seizures include:

• Deep brain stimulation (DBS): A device that interrupts the erratic electrical signals that cause seizures by providing consistent electrical stimulation.
• Responsive neurostimulation (RNS): A device that monitors brain activity, detects a seizure, and then delivers a mild electric current to stop seizures.
• Vagus nerve stimulation (VNS): A device that stimulates the vagus nerve in your neck, which connects to the brain, reducing temporal lobe seizure frequency.

Epilepsy diet

A ketogenic (keto) diet—which is high in fat and protein and low in carbohydrates—may help reduce seizures for some people. Epilepsy diets work best when combined with medications or other treatments.

FAQs about temporal lobe epilepsy