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Re: temporal lobe seizure disorder

Posted By CCF Neurology ND:NT on October 24, 1998 at 19:17:50:

In Reply to: temporal lobe seizure disorder posted by Sethanne on October 24, 1998 at 18:13:29:

First, thank you for this page.  I found it while searching for any information on temporal lobe disorders I could find.
I have diabetes, am 55 yrs old, and have been told I now have
temporal lobe seizure disorder, PTSD, and ultra-rapid cycling.
These form a general cluster of symptoms consistant with a lowered seizure
threshhold.  An abnormal EEG targeted the seizure disorder.  
Evaluation for depression targeted the others.  The ultra-rapid
cycling was established by a reaction to anti-drepessants.
The conditions are somewhat refractory.  I take tegretol, neurontin,
seroquel as well as a panel of certain herbs (under doctor's direction).
The control is not strong.
I have become familiar with what happens during a PTSD episode and with
ultra-rapid cycling, but I am not comfortable identifying what a 'seizure'
might be.  I have not had any loss of consciousness - ever.  I seem to
have strange auditory sensations but retain awareness.  Are such
sensations typically a few seconds long, less than one second, many seconds long?  Are they commonly followed by post lictal (?) fatigue.  
Are auditory sensations typical for temporal lobe seizures?
I am looking for the general information on the seizure itself and how
I might identify it when it occurs.
Thanks again.

Dear Sethanne:
1)  The vast majority of seizures of any type (including seizures originating from the temporal lobe) are NOT subtle. With regard to temporal lobes seizures specifically, the following sequence of symptomatology is commonly observed:
     (i) AURA - this is a sensation which is subjectively perceived by the patient, and cannot be observed by onlookers. Auras can last for several seconds to a few minutes before progressing to the next stage, or be spontaneously resolve without evolution. Auras may no occur at all in a substantial subset of cases. Auras are of various types; a few of the more common ones noted in temporal lobe seizures are (a) a non-descript abdominal uneasiness or fluttering sensation (epigastric aura) - occurs in the vast majority of cases that have auras (b) a psychical sensation of "having been there before" (deja-vu) (c) smell (olfactory aura) (d) sounds, simple or complex/formed (auditory aura)
    (ii) SEIZURE - EARLY STAGE (also called complex partial seizure) - In the vast majority of temporal lobe seizures, an observer commonly notices that the patient stares, looks "spaced out", and fails to respond (or inappropriately responds) to calls or commands. Although the patient usually looks "awake" in this phase of the seizure, he or she loses mental contact with the world. Spontaneous half-purposeful repetitive hand movements and chewing/lip-smacking movements are commonly seen during this stage ("automatisms"). This stage commonly ends spontaneously in several seconds eo a few minutes, and the patient enters stage (iv) directly. Far less commonly, the patient may go through stage (iii) before reaching stage (iv)
   (iii) SEIZURE - SECONDARY GENERALIZATION - This occurs very infrequently in temporal lobe epilepsy. The patient may have numerous "comples partial seizures" daily, weekly, or monthly, but may "generalize" only once in several months, or even never. In this stage the patient has a violent convulsion which may have phases of head turning, generalized stiffening (tonic phase), and generalized jerking (clonic phase). Clothes may be wet, and tonguebite may occur. Lasts 1-2 minutes.
    (iv) POST-ICTAL STAGE - after the seizure ends in stage iii or iv, the patient is commonly confused and drowsy to a variable degree for a variable duration.
2) I would be most reluctant to make a diagnosis of temporal lobe epilepsy just on the basis of an abnormal EEG, in the absence of a clear history of seizures similar to what I have described above. The diagnosis of epilepsy has very serious consequences on an individual's lifestyle and occupation. In most states there are major restrictions on driving, for instance.
3) Types of epilepsy other than temporal lobe epilepsy exist, and their description differs from the one above. Most of these, however are as subtle as your description suggests. And almost none of them are diagnosed solely on the basis of an abnormal EEG.
In case you wish to have a second opinion and want to have the diagnostic issues resolved with certainty, any of the epileptologist at the Cleveland Clinic would be most happy to see you. The epilepsy department at the Cleveland Clincic is one of the most acclaimed epilepsy departments in the world, both in terms of research, and in patient care.
Appointments can be made by calling (800)223-2273, or (216)444-5559 locally
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