Seizures and Epilepsy

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February 2, 2024
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Seizures and Epilepsy

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Video electroencephalogram telemetry in temporal lobe epilepsy. - Abstract - Europe PMC

Mani J. Video electroencephalogram telemetry in temporal lobe epilepsy. Annals of Indian Academy of Neurology.

2014 Mar;17(Suppl 1):S45-9. DOI: 10.4103/0972-2327.128653. PMID: 24791089; PMCID: PMC4001214.

The 2 subtypes of temporal lobe seizures are mesial temporal lobe seizures including the hippocampus and lateral / neocortical temporal lobe seizures.

Mesial temporal lobe epilepsy (MTLE) involves the medial or internal structures of the temporal lobe. Seizures often begin in the hippocampus or surrounding area. MTLE accounts for almost 80% of all temporal lobe seizures. Seizures that arise in the mesial temporal lobe may be characterized by distinctive seizure onset features. Autonomic (epigastric sensation/abdominal discomfort), cognitive (deja vu/jamais vu), emotional (fear) or sensory (unpleasant olfactory/gustatory) focal seizures can occur in isolation or followed by onset of behavior arrest with progressed impaired awareness. Automatisms can be oral including chewing, lip smacking, swallowing, and tongue movements. Manual automatisms can also be a feature of these focal seizures. Autonomic phenomena (pallor, flushing, tachycardia) are also common.

Question:
Which of the following is not true about lateral temporal lobe seizures?
A
Evolution to a focal to bilateral tonic-clonic is less common.
B
Has a shorter duration than mesial temporal lobe seizures.
C
Feature of onset impaired awareness occurs earlier.
D
Can spread and involve motor cortex.
E
Correct Answer: 
A

Lateral temporal lobe seizures may have an initial focal seizure with auditory or vertiginous features. The focal sensory auditory seizure is usually a basic sound such as buzzing or ringing (rather than formed speech). If the sound is heard in only one ear it suggests the seizure is in the contralateral hemisphere. In comparison to mesial temporal lobe seizures, lateral temporal seizures are of shorter duration, and the onset of impaired awareness is an earlier feature (the initial aware phase is not as prolonged). Lateral temporal lobe seizures may spread and motor features such as contralateral upper limb dystonia, facial twitching or grimacing, and head and eye version may occur. Evolution to a focal to bilateral tonic-clonic seizure is more common than in mesial temporal lobe seizures.

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