Epilepsy & Seizures

Temporal lobe epilepsy (TLE)

Implicit in the name, TLE is epilepsy that originates in the temporal lobe of the brain. TLE accounts for 60 percent of all focal epilepsy. TLE causes focal (partial) seizures that may either impair awareness (called complex partial seizures) or slightly alter perception (called simple partial seizures) also referred to as “auras”. It often begins in children around 10 years old but can start at any age. Some brain functions of the temporal lobe include emotions, memory, speech, and hearing. Becoming seizure free will generally require surgery. It is unlikely that medications alone will eliminate seizures, although medications can help control seizure frequency, duration, and intensity.

There are two forms of TLE: 

• Mesial temporal lobe epilepsy (MTLE): Around 80 percent of TLE take this form. It begins in the inner area of the temporal lobe such as the hippocampus. It can cause tonic-clonic seizures.
• Lateral temporal lobe epilepsy (LTLE): This form begins in the outer region of the temporal lobe. It can cause simple and complex partial seizures.

Frontal lobe epilepsy (FLE)

This type of epilepsy can begin at any age. It causes electrical activity in the frontal lobes. FLE causes simple or complex focal seizures or a combination of the two. Usually anti-epileptic drugs can manage FLE, however, surgery or neurostimulation may be necessary. 

Benign Rolandic Epilepsy (BRE)

This form of epilepsy is one of the most common. BRE is also called benign epilepsy with centrotemporal spikes because the seizure is caused by electrical activity that begins in the rolandic/ centrotemporal area of the brain. It is the most common epilepsy in children, affecting children between the ages of 3 and 12 years. BRE causes motor and sensory symptoms in the face including twitching, drooling, numbness, tingling, and speech impairment. BRE develop into tonic-clonic seizures affecting both hemispheres of the brain.

Photosensitive Epilepsy

For an estimated 3 percent of epilepsy sufferers, their condition can be triggered by lights that flash at certain speeds or in certain patterns. This is generally more common in young children and tends to lessen as they age. It causes tonic-clonic seizures.

Catamenial epilepsy

Also called menstrual seizures, this form of epilepsy is specific to menstruating women. Women who suffer from catamenial epilepsy experience more frequent seizures at certain times during their menstrual cycle. Menstrual seizures are caused by hormone changes before or during menstruation including declining progesterone and increasing estrogen levels. Imaging studies like EEG, MRI, and CT can help diagnose catamenial epilepsy, however, a menstrual/seizure journal will help in diagnosis. If seizures are identified to increase during menstrual periods relative to non-menstrual periods, this is an indication of catamenial epilepsy. Catamenial epilepsy is generally treated with anti-seizure medications and drugs that can regulate hormone levels.

Nocturnal Epilepsy

This form of epilepsy only occurs when a person is sleeping, generally in stages of lighter sleep. Between 7.5 and 45 percent of epilepsy sufferers only experience seizures while they are sleeping. For some people, establishing a consistent sleep cycle (circadian rhythm) can help decrease the frequency of nocturnal seizures. Some anticonvulsants may also help but only those that do not disrupt sleep stages. Seizures during the night may go unnoticed. If you awaken with injury, weakness, or headaches this may be a sign of nocturnal epilepsy. Other signs include loss of bladder control during the night, waking in positions you did not fall asleep in, or a disheveled area around you. Sleeping with a partner may also help identify some of the symptoms of seizures during the night.

Refractory Epilepsy

This is also called uncontrolled, drug-resistant, or intractable epilepsy. It refers to epilepsy which is resistant to medication. Refractory epilepsy is common, affecting about 33 percent of epileptics. It is important to choose an experienced epilepsy specialist that prescribes the correct medications for you seizure type. If two types of anti-seizure medications are used to no avail, dietary therapies, lifestyle improvements, surgery, and neurostimulation are the next line of treatment for refractory epilepsy.

Sudden Unexpected Death in Epilepsy (SUDEP)

This refers to the sudden death of a person suffering from epilepsy, who is otherwise healthy, that upon post-mortem evaluation does not have a cause of death. If death is caused by drowning, trauma, or status epilepticus (prolonged seizures) this is not considered SUDEP. The exact cause of SUDEP is unknown and may differ from case to case. Some studies indicate cardiac, respiratory, and neurological factors may contribute to SUDEP.

Lennox-Gastaut syndrome (LGS)

A form of severe epilepsy affecting infants and children (typically between 3 and 5 years old). LGS causes multiple types of seizures including tonic, atonic, and absence seizures. They can also cause cognitive and behavioral impairments like mental retardation (i.e. learning problems) or psychomotor regression (losing recently attained abilities). LGS may delay children from attaining developmental milestones like crawling and sitting.

Dravet Syndrome

A severe and rare form of epilepsy affecting infants. The onset of Dravet Syndrome usually occurs during fever or illness. The most common seizures are myoclonic (muscle twitching or jerking) and tonic-clonic seizures (full body stiffening followed by jerking seizures on the ground). Seizures can be triggered by body or environmental changes in temperature, flashing lights, or strong emotions. Children generally develop disabilities as they age. Treatment can include seizure medications, diet, and neurostimulation. Surgery is not commonly used.