Neocortical temporal lobe seizures

Fernando Cendes MD PhD (Dr. Cendes of the University of Campinas - UNICAMP has no relevant financial relationships to disclose.)
Jerome Engel Jr MD PhD, editor. (

Dr. Engel of the David Geffen School of Medicine at the University of California, Los Angeles, received honorariums from Cerebel for advisory committee membership.

)
Originally released February 12, 2004; last updated January 18, 2021; expires January 18, 2024

Overview

Clinical expression of temporal lobe seizures depends on the localization of the epileptogenic zone, type of the epileptogenic lesion, and age. Focal seizures in neocortical temporal lobe epilepsies may manifest with or without impaired awareness (Fisher et al 2017; Falco-Walter et al 2018).

Neocortical temporal lobe focal aware seizures (previously classified as simple partial seizures or auras) can be brief, frequently with auditory features, such as buzzing, roaring, radio- or motor-like sounds, and distortions in sounds and words (Fisher et al 2017; Falco-Walter et al 2018). However, the focal seizures often occur with impaired awareness, which may present with auditory symptoms, visual misperceptions, language impairment (ictal aphasia), or ill-defined cephalic or vertiginous sensations. These seizures may progress to a bilateral tonic-clonic seizure (focal onset bilateral tonic-clonic seizure) (Fisher et al 2017; Falco-Walter et al 2018).

The EEG abnormalities are more complex in infants and children than in adults. Motor manifestations, including tonic, clonic, or complex behaviors as well as infantile spasms, predominate in infants. Classical impaired awareness focal seizures with behavioral arrest and automatisms and clear lateralizing signs are rare in young children and mainly occur after 2 years of age.

Key points

 

• The most common lesions causing neocortical epilepsies are low-grade tumors, malformations of cortical development, posttraumatic, ischemic, and inflammatory-infectious scars, and cavernous angioma.

 

• Neocortical temporal lobe seizure semiology varies considerably according to the area of the temporal lobe involved.

 

• Classical lateral temporal focal seizures are characterized by auditory, language, or visual symptoms or ill-defined cephalic or vertiginous sensations.

Historical note and terminology

Although nonconvulsive seizures with complex behaviors have been recognized since antiquity (Temkin 1945), their relationship to temporal lobe origin was first described in the late 1800s by Jackson (Jackson 1898; Jackson 1958). The psychic and motor characteristics of these seizures first prompted the designation of psychomotor seizures (Gibbs et al 1938; Gibbs et al 1948). With the advent of electroencephalography and the increased interest in surgical intervention, the anatomical significance of these seizures led to them being labeled temporal lobe seizures (Sutton et al 1987).

The majority of temporal lobe seizures originates in the mesial structures, primarily in the hippocampus, with the rest beginning in various temporal neocortical regions (Williamson et al 1997b).

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