Left Temporal Lobe Seizures

[Linda]

I was diagnosed with Left Temporal Lobe Seizures at age 7 and am now 33.  A seizure for me consists of a blank stare, afterwards I feel out of it, like I am not really functioning (although I can go about normal everyday things) which can last for hours, I feel off balance and I become very tired.  I think I am having several small seizures during the day that go unoticed by other people and then every few weeks I will have one where I will stare for 10 seconds or more that my husband will notice.  After a longer seizure, I will sleep for several hours.  On a day in which I have a longer seizure, I am irritible and moody. I don't have any other outward seizure signs, like picking at myself, hand shaking, numbness, hearing things, smelling, nothing that would indicate to me or other people that a seizure may be comming on.  However riding in a car, working on the computer, sometimes watching the TV, or right after I eat a meal, I feel bad. I have a hard time with comotion around me such as being in a mall, I am whipped by the time we get home.  There is a history of seizures in my family.  (Maternal Grandmother - Grand Mals, Maternal Uncle - Petit Mals, 15 yr old niece - Left Temporal Lobe seizures.) For the past 10 years I have been unable to find a medication that will control these seizures. As a child I took meboral, in my teens I didn't take anything.  (Tegretal - Allerigic reaction, Dilantian - Allerigic Reaction, Lamictal messed me up, Phenobarbital caused hyperactivity and nervousness)  I took Depakote for 6 years which helped but did not control the seizures 100%, however I didn't go through the moods.  I have been doing research on my own and does a seizure in the temporal lobe control emotions?  I get angry, cry easily etc.  Also some of my EEG's come out normal and some show seizure activity in the left temporal lobe.  My MRI and CT Scans were normal.  Why are my seizures so hard to control?  I have had depression and anxiety ruled out by a psychologist. What can you tell me about this type of seizure?  Or could this be something else?  Other than this, I am in good health.

[CCF Neuro[P] MD, RPS]

Dear Linda:

Sorry to hear that you have epilepsy.  Temporal lobe epilepsy, especially mesial temporal lobe seizures are difficult to control.  Many people are refractatory to medications.  One option is epilepsy surgery.  We and others have found that if the correct conditions (seizure focus location, language etc) are found, surgery can make a person seizure free with minimal side effects.  But that is something you will have to talk about with your epileptiologist.  The location of the seizure onset can cause abnormal activity in the surrounding brain areas and induce emotional changes, and others that you talked about.  There are other medications that you did mention such as topramax, gabitril, neurontin, etc.  Although, once a person fails the major medications, the likelihood of becoming seizure free on other medications becomes less likely, you may want to try the others that you haven't tried.  When was your MRI?  There are new programs and higher resolution MRIs that can detect areas of sclerosis or dysplasia that the MRI scans of a few years ago would have missed.  

I think I would see if surgery is an option, and also you may want to give one of the newer medications a trial.

Sincerely,

CCF Neuro MD

[JANET email at [e-mail]]

trying to find out information on b12 deficiency/pernicious anemia/ multiple sclerosis. i dont understand what is totally gooibg on i have a neurlogist and a internal medicine drs. this started out being b12 deficiency after a muscle biospy and 23 tubes of blood now it is progressing to  pernicious anemia. i did have 6 weeks of b12 shhots trying get the body to accept it. but after a blood test again the hystomine levels were  vey high  the internal dr. stated that it was nnow pernicous anemia. i am now having terrible back pain in the lower back and in the back between the shooulders there is a rash after i terrible back pain that has stayed since this pain its been 9 weeks and hasnt gone away, also i am having paain in my right eye their is a vein that bulged out when this pain comes the eye waters very bad and burns and sting terribly. i also am having in my feet and hands coldness feels like when yoou have been in the snow and they have frozen and the pain of unthawing,plus going numb.and they having a feeling of very cold when you toouch them. them. also where they did the biospy there is pain coming and going like a pinching and sometimes like a shock. i woould appricate you responding to my question.

[bj]

Why is it that a CT scan can be "normal" and then have an MRI?  If sclerosis does show up on the MRI, what could have caused this scarring and what can be done about such scarring?

Would vascular irregularities show up in a CT scan?  I'm given the impression by some radiologists that if nothing showed up on the CT scan, "you've got nothing to worry about". Can temporal epilepsy still exist even with the report of nothing showing up in the CT scan?  With irritability as part of the symptoms of my temporal epilepsy, this attitude of "nothing is wrong" only makes me feel worse.

Thank you for your assistance!  Good luck to others with epilepsy!

[CCF Neuro[P] MD, RPS]

Dear BJ:

Prior to the MRI era, epilepsy surgery was based only on the large lesions that could be detected by physical exam and CT (which wasn't many).  I do not know any epileptologist that would base their conclusions about the lesions inducing epilepsy based solely on CT.  MRI is standard of care.  Vascular lesions can be detected on CT, especially if they are large and if there is hemmorhage.  The fine vascular abnormalities in stroke or vasculitis require MRI with MRA.

Sclerosis is a pathway or response from an insult.  This can be due to hemorrhage, anoxia, demyelinations, infection, etc.  MRI is the best to detect this lesion.

CCF Neuro MD

[Laurie]

I was diagnosed with complex partial temporal lobe epilepsy in 1996...I had several Tonic Clonic seizures during the night and continued to have compex partial seizures for several days.  I was hospitalized and had a lot of hallucinations.  Over the 6 days I was hospitalized I had 2 MRIs and 2 CT scans....nothing that would indicate epilepsy or seizures showed up...After interviews with several neurologists, I realized that I may have been having simple partials seizures or auras for several years...actually 20 years!...Is it common for nothing to show up on the tests?..I now take 500 mg of dilantin daily and have a few aura experiences every 2 or 3 months.

[Laurie]

oops!!!  I put my question in the wroing place...It was supposed to be posted as a question...not a comment ...let's see if I can figure this thing out...sorry...

[chad]

My wife has seizure disorder.  To date the exact cause hasn't been pinpointed.  We both suspect it is a Temporal Lobe type seizure.  We read in the Merck Manual that damage to right temporal lobe may cause personality changes such as humorlessness, unusual degrees of religiosity (have no idea what that means, not in dictionary), obsessiveness and loss of libido.

My wife hasn't had a seizure for two years now.  She had 4 grand-mal since falling on her head ten years ago.  she has had numerous petit mal which are just blanking out.  The seizure activity now is controled with Topamax.  

My question is and I'm sorry if this sounds terribly insentive, the Merck Manual hits it on the nose.  My wife is humorless and has no libido what so ever.  My wife hasn't kissed me in over 10 years.  When I go to kiss her, she turns her head forcing me to kiss her cheek.  There are times when trying to give her back rub or just reach out to touch her or hug her, she pushes me away. Sex is there, but there is no emotion involved.  After ten years of this my fraustion is mounting (I'm 30 years old she is 29).  We have many arguments.  She stongly feels that she has injured her right temporal lobe and that is the reason for her not to giving any emotion in our relationship.  Is this ********? (Excuse my french) Or is this valid symptom of the seizure?  Do I have to live with an emotionless marriage?  Do other people have this problem?  Do we need to see a neuro-psych or psychologist?

[CCF Neuro[P] MD, RPS]

Dear Chad:

I am so sorry to hear about the difficulties that you and your wife are having.  Unfortunately, we see this sort of thing in chronic epilepsy.  Traumatic induced seizures are sometimes difficult to control.  What did the EEG show and what did the MRI show.  Right sided epilepsy can give one a flat personality.  Any seizure disorder can induce personality changes and the medications can also induce side effects of their own.  One well known side of effect of topamax is decreased energy and would tie into sex.  Chronic illness also has baggage of its own, especially depression, which would feed into the emotional aspect of her symptoms also.  I would see if your wife might be a surgical candidate, or if her epilepsy might be controlled by other medications or techniques (vagal nerve stimulator).  I hope that changes as in either of the above might help matters.  It is so difficult to live in a emotional-deprived marriage.  Hang-in there.

Sincerely,

CCF Neuro MD