Temporallobsepilepsi

Temporallobsepilepsi, or temporal lobe epilepsy (TLE), is a focal epilepsy in which seizures originate from the temporal lobe of the brain, most often from medial structures such as the hippocampus and amygdala. It is the most common form of focal epilepsy in adults and can begin in childhood or adulthood. Many individuals have seizures that are difficult to control with medications, making TLE a leading cause of drug-resistant epilepsy.

Most cases involve mesial temporal sclerosis, a scarring process of the inner temporal structures. Other structural causes include cortical malformations, tumors, vascular lesions, infections, or traumatic injury. The result is abnormal neuronal networks that predispose to spontaneous seizures.

Clinical features commonly include an aura such as déjà vu, fear, or olfactory/gustatory sensations, followed by impaired awareness and automatisms (repetitive movements like lip-smacking). Seizures may be brief or evolve with impaired consciousness and postictal confusion. Memory and emotional experiences can be affected, reflecting the temporal lobe’s role in memory and emotion.

Diagnosis relies on history and long-term video-electroencephalography monitoring, supported by imaging. MRI often shows mesial temporal sclerosis or other temporal lobe lesions; functional imaging (PET/SPECT) may show metabolic changes in the temporal region. EEG typically demonstrates focal epileptiform discharges originating from the temporal lobe.

Treatment starts with antiepileptic drugs, but a substantial subset has drug-resistant disease. For these patients, surgical options such as anterior temporal lobectomy or selective amygdalohippocampectomy can achieve substantial seizure relief, particularly in MTLE with hippocampal sclerosis. Less invasive alternatives include laser interstitial thermal therapy and neuromodulation (vagus nerve stimulation, responsive neurostimulation, or deep brain stimulation of the anterior nucleus of the thalamus). Prognosis varies with the location and pathology of the seizure focus and with treatment response; many patients experience improved seizure control and quality of life after intervention.