Temporal Lobe Seizures and Depression

[Margaret Lonergan]

My seizures follow the classic sequence: deja vu; epigastric aura; olfactory aura. I have only ever had one generalized seizure. I am 33.

In the immediate aftermath of an episode, I feel drowsy and often have quite severe migraine-like headaches with neck and shoulder pain. The seizures and side effects in themselves do not bother me (In fact, the insights into memory and temporality that they have given me have contributed to my work as a visual artist).

What I find very disturbing and distressing is that as few as two consecutive seizures across three days immediately triggers an episode of depression that can continue for up to ten days. This depression consists of overriding feelings of oppression, darkness, lethargy and sadness, accompanied by mild panic attacks and a perplexing combination of claustrophobia and agoraphobia. What frustrates, angers and distresses me is that these feelings have no relationship to any of the real events of my life, nor do I ever suffer from any form of depression when I am not in an epileptic phase. These sudden and short-lived depressive episodes seems to me to be neuro-chemical in origin.

It is largely because of the depressive episodes caused by the epilepsy that I remain constantly medicated. Otherwise, I think that I would try to manage the condition without drugs. Currently, I am on combination drug therapy: Tegretol 800mg with Lamictal 200mg. I tolerate the drugs very well with no tangible side-affects. Despite the drug therapy, which is usually very effective, I still enter active epileptic phases where I have sequences of seizures, especially if I am unwell in some other way (as happened recently after a bout of Shingles), and then the depression follows.

My questions are: What neuro-chemical activities are taking place to cause this depression? Is it a normal consequence of this kind of epileptic seizure? Is there any way to prevent or alleviate it? Has any specific research been carried out in this area? I also welcome any other information, thoughts or reflections you may have on this subject.

Many thanks for your time and attention.

[CCF Neuro[P] MD, RPS]

Dear Ms. Lonergan:

What you describe is not uncommon in temporal lobe epilepsy.  Do you have isolated mesial temporal lobe (hippocampal sclerosis)? or cortical dyplasia of the temporal lobe?  The temporal lobe is closely associated witht the limbic system and and therefore emotions such as depression can happen after a seizure.  Temporal lobe epilepsy is difficult to control, and many find relief from epilepsy surgery.  Have you looked into this entity, there is a almost 80% cure rate if you have the correct lesion. There is a population of depressed patients who have an imbalance of serotonin, and some patients do not respond to serotonin agonist or reuptake inhibitors.  Some patients who have depression we have no idea why.  Since yours is seizure related, likely it is not serotonin, but more likely the abnormal consequence to stimulation of the limbic system.  

Sorry, I'm not much help.

Sincerely,

CCF Neuro MD

[Valencia]

Hello Margaret
I too experience that seizures sometimes helps me be more creative and imagnitive in a really good way. I am sorry to hear of your depression though. I too have headaches afterwards and am very tired. I have felt at different times depressed for various reasons after a seizure sometimes it's because I just get so worn out by them and can't function with my 2 daughters, or the headaches are to  much and I can't focus well at these times I always hope that no one takes me to serious because really I am just having after effects of my seizure. What really helps me is prayer.
I hope that the Doctor is able to give you excellent advice I am sure he will. I'll pray for you too

[CCF Neuro[P] MD, RPS]

thanks for the comments.

CCF Neuro MD

[Wayne]

Since my onset of temporal lobe seizures five years ago I am mostly an emotional wreck. After these went untreated for a couple years something snapped and I have been extremely sensitive emotionally, have a bad temper, go into deep depressions, etc. Even after going several weeks with no seizures, I feel pretty much the same though I'm on a slight roller coaster. I've read where seizures can cause permanent brain damage and would be interested if doctors here subscribe to that idea or if my condition will straighten out if the seizures are properly controlled long enough.

To complicate matters, and perhaps the cause of the seizures, was a ruptured disk in my cervical spine that received surgery last year.

Wayne

[CCF Neuro[P] MD, RPS]

Dear Wayne:

In the adult population, temporal lobe epilespy is difficult to treat.  So, seizures will reoccur.  I hope that with medication yours are controlled, but many patients are not so lucky.  There is no way to predict if your emotions will smooth out or correct.  The epileptic focus is still present and it remains pathological even with seizure control.  If surgery can be done your your type of epilepsy, that would be the way to cease having seizures and hopefully correct the emotional problem.

Sincerely,

CCF Neuro MD

[Judi H]

After suffering from what appeared to be severe temper tantrums and depression most of my life, a sharp psychiatrist diagnosed temporal lobe epilepsy.  We have been using Depakote and Neurontin as well as an antidepressant to treat this and what a difference it has made in my life.
Good luck to all

[CCF Neuro[P] MD, RPS]

thanks for the comments.

CCF Neuro MD

[Dawn]

I didn't want to make this long but I am only going to do this once.
After brain surgery ( meningioma ) I ended up with a partial seizure disorder. With the usuall symptoms...aura, spells of unawareness,etc. I am not complaining by any means. I thank God and neurosurgeon every day.I am laughing my way through the rest of my life ! It did slam me with depression for the first time in my life ( didn't even recognize it when it hit me ) but it works for me to take zoloft.My question is about anti-seizure meds. I am on only 300 mg. of dilantin per day. I do not want to have to take any, so I really didn't want to raise it. I continue to have seizure activity and I want to know if it is ok to just ignore the symtoms.I mean to learn to live with it. Also while I am on here I'd like to know if anxiety and/or stress can bring this on more. To shoot another question at you that is affecting my life extremely...is this the reason for my awful memory problems ? or could this be from being overwhelmed with stress and/or anxiety ? Just to paint a better picture, in the last two years I had the brain tumor up to when I couldn't even walk or talk and ended up in emergency room, my husband suffered a painful death from cancer while I was still in recovery and during this time that I was taking care of him I also had my mamm come back abnormal and had breast surgery (benign). Thank you.

[Dawn]

*laughing at myself*, I said I was going to post only one time but I forgot to ask another question ( this memory ! ). I wanted to know if I should, and how often, return for cts or mri's to check on return of brain tumor. thank you

[CCF Neuro[P] MD, RPS]

Dear Dawn:

It would depend if the meningoma was benign or malignant.  If it was malignant then every few months is what we do.  If it is benign then probably yearly after an initial MRI in several months.  You should really talk to your neurosurgeon about what he/she usually will do with the type of meningoma you had.

Uncontrolled seizures have a higher incidence of sudden death.  There is a higher incidence of accidental death (bath tub drownings, etc), and the change of injury due to seizures.  I would highly recommend that you get your seizures under control.  Yes stress can make seizure activity worse.  However, many think that uncontrolled seizure activity can make the frequency of seizures worse and the ability to control more difficult.

Sincerely,

CCF Neuro MD

[Dawn]

Thank You.

Dawn

[CCF Neuro[P] MD, RPS]

your very welcome.

CCF Neuro MD

[jean]

I'm 37 and going through the diagnostics for temporal lobe epilepsy, but so far the testing is indicating epileptiform activity bilaterally with left worst than the right.  Reading others comments makes me feel a bit better to know that I'm not going through the same emotions alone and there IS a reason for the emotional roller-coaster.

I recently had a growth removed that turned out to be melanoma in situ (but I'm still waiting to have further excisional surgery to ensure all the growth was caught).  Another growth was removed last week to which I'm still awaiting the pathology report. Can melanoma metastisize and cause epileptic-type symptoms? The epileptic symptoms started about a year ago.  Perhaps it is simply coincidence.

Being a nurse, I want to return to nursing.  Do you know how likely it is for a nurse to work as one if temporal-lobe epilepsy is confirmed?

Sorry to be so long-winded.  Thank you for the opportunity to ask these questions.  Good luck to everyone else!

[CCF Neuro[P] MD, RPS]

Dear Jean:

I am sorry to hear about your seizures.  Unfortunately, melanoma can mets to the brain and induce seizures.  Whether your seizures are related I can't tell you as I haven't seen the MRI scan.  I would talk to your neurologist about your particular situation.  I hope you go back to work soon.

Sincerely,

CCF Neuro MD

[anthony]

about twenty three years ago,a cyst was discovered on the
temporal lobe of the brain. To date,I have no symptoms but
worry alot about this...Should I be concerned?
Thank you.

[CCF Neuro[P] MD, RPS]

Dear Anthony:

Since you have not experienced any effects from your cyst, I think your in a good state.  To tell you not to worry about it would be alittle heady of me.  One always has to worry about things that are abnormal, at least alittle.  But, twenty years is a good track record.  Alot depends on what type of cyst you have.  Since I do not know, I can't tell you much more that I hope that the next twenty years are just like the last.

CCF Neuro MD

[lisa]

I had spinal meningities 2 1/2 yrs ago had a cat scan done there was a dark spot on my right side but they called it normal.After being released from the hospital i had strange symptoms but the dr. i had at the time told me i was well.Well here i am 2 1/2 yrs later i have went through many tests the MRI showed a 2 centimeter abnormal area in my right frontal lobe.The EEG showed seizure activity in all areas of the brain stronger on the right side.I am now on tegratol 600ml a day.I continue to have numbness in my face. twitcing in my left eye on and off.The spinal fluid came back normal dr.s still dont know what this thing is in my brain.My question is could this damage have come from the spinal meningities.Should i go get a second oppion and will i ever work again.Will the seizures get worse or ever go away.Im 32 have 2 children i want my life back.Im having peti mals and am not allowed to drive right now he said he would check my blood levels.They would monitor this area in my head every six months that seems so far away.could this thing get bigger.Please help i am so very frustrated its been 2 months and i feel i am right back where i started.Sorry it is so long your advise would be greatly appreiated.Thank you in advance.Lisa

[lisa]

What information can you provide regarding the use of Zopamax for bipolar disorders and/or migraine prophalaxis?  My understanding is the drug has only been approved for seizure disorders.  Any new trials?

[CCF Neuro[P] MD, RPS]

Dear Lisa:

There are no published data on the use of Topramax and migraine.  I know they are currently doing some small trials.  As far as bipolar disease, I also do not know of any published data.  There is some data with valproate and it seems to be beneficial for both migraine and biopolar disorders.

Sincerely,

CCF Neuro MD

[aaron1973]

A related discussion, Why do i feel so helpless because i'm having seizures was started.