An unusual sensation or emotion, known as an aura, may precede a temporal lobe seizure, acting as a warning. Not everyone who has temporal lobe seizures experiences auras, and those who do have auras may not remember them. The aura is actually a small seizure itself — one that has not spread into an observable seizure that impairs consciousness and ability to respond. Examples of auras include:

• A sudden sense of unprovoked fear
• A deja vu experience
• The sudden occurrence of a strange odor or taste
• A rising sensation in the abdomen

People who have temporal lobe seizures usually remain partially conscious during a seizure, but they lose awareness of their surroundings and usually don't remember what happened.

A temporal lobe seizure usually lasts 30 seconds to two minutes. Characteristic signs and symptoms of temporal lobe seizures include:

• Loss of awareness of surroundings
• Staring
• Lip smacking
• Repeated swallowing or chewing
• Unusual finger movements, such as picking motions

After a temporal lobe seizure, you may have:

• A brief period of confusion and difficulty speaking
• Inability to recall the events that occurred during the seizure
• Unawareness of having had a seizure until someone else tells you

In extreme cases, what starts as a temporal lobe seizure evolves into a grand mal (tonic-clonic) seizure — featuring convulsions and a loss of consciousness. About half of people with temporal lobe seizures never experience a grand mal seizure.

When to see a doctor
Seek medical advice in these circumstances:

• When the number of seizures experienced increases significantly without explanation
• When new signs or symptoms of seizures appear

Seek emergency medical care if a seizure lasts more than 5 minutes.

If rhythmic muscle contractions or jerky movements occur in someone having a temporal lobe seizure, a grand mal seizure may be developing. Follow these tips:

• Call for medical help immediately.
• Gently roll the person onto one side and put something soft under his or her head.
• Loosen tight neckwear.
• Don't put anything in the mouth — the tongue can't be swallowed and objects placed in the mouth can be bitten or inhaled.
• Don't try to restrain the person. Look for a medical alert bracelet, which may indicate an emergency contact person and other information.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

During normal waking and sleeping, your brain cells produce varying electrical activity. If the electrical activity in many brain cells becomes abnormally synchronized, a convulsion or seizure may occur. If this happens in just one area of the brain, the result is a focal or partial seizure. When this occurs in an area of the brain known as the temporal lobe, it's called a temporal lobe seizure.

Temporal lobe seizures can be a result of:

• Traumatic injury
• Infections, such as encephalitis or meningitis, or history of such infection
• A process that causes scarring (gliosis) in a part of the temporal lobe called the hippocampus
• Injury due to a previous lack of oxygen
• Blood vessel malformations in the brain
• Stroke
• Brain tumors
• Genetic syndromes

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Over time, repeated temporal lobe seizures can cause the part of the brain that's responsible for learning and memory to shrink. This area is called the hippocampus. Brain cell loss in this area may cause memory problems.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You're likely to start by first seeing your family doctor or a general practitioner. However, you'll probably be referred to a doctor who specializes in nervous system disorders (neurologist).

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you or your child has experienced, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, as well as any vitamins or supplements, that you or your child is taking and the dosages used. Write down the reasons any were discontinued, whether this was because of side effects or lack of effectiveness.
• Ask a family member to come with you to the doctor, because it's not always easy to remember everything you've been told during your appointment. Also, since memory loss can happen during seizures, many times an observer is able to better describe the seizures than the person who's had the seizure.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time. List your questions from most important to least important in case time runs out. For temporal seizure, some basic questions to ask your doctor include:

• Is the diagnosis epilepsy?
• Will more seizures occur? Will different types of seizures occur?
• What kinds of tests are needed? Do these tests require any special preparation?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the primary approach that you're suggesting?
• Are there any activity restrictions that need to be followed?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you or your child first begin experiencing symptoms?
• Did you notice any unusual sensations prior to the seizure?
• How often do the seizures occur?
• Can you describe a typical seizure?
• How long do the seizures last?
• Do the seizures occur in clusters?
• Do they all look the same or are there different seizure behaviors you or others have seen?
• What medications have you or your child tried? What doses were used?
• Have you tried any medication combinations?
• Have you noticed any seizure triggers, such as sleep deprivation or illness?

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your doctor will need a detailed description of the seizures. This will probably need to come from someone who has witnessed the seizures, because most people who have temporal lobe seizures don't remember the episodes.

During the office visit, your doctor may perform a neurological exam that tests your reflexes, muscle tone, muscle strength, sensory function, gait, posture, coordination and balance. Your doctor may also ask questions to test your thinking, judgment and memory.

Blood tests may also be needed. And your doctor may also suggest scans or tests designed to detect abnormalities within the brain.

Electroencephalogram (EEG)
An EEG displays the electrical activity of your brain via small electrodes affixed to your scalp with paste or an elastic cap. You lie still during the test, but at times you may be asked to breathe deeply and steadily for several minutes or to stare at a patterned board. At times, a light may be flashed in your eyes. Typically, a recording during a brief period of sleep is obtained as well. The electrodes pick up the electrical impulses from your brain and send them to the EEG machine, which records your brain waves on a moving sheet of paper or digitally on a computer.

In some cases, your doctor may recommend video-EEG monitoring, which usually requires a brief hospital stay. This can be helpful because it allows your doctor to compare — second by second — the behaviors observed during a seizure with your EEG pattern. The comparison helps your doctor pinpoint where your seizures come from, which may help in determining treatment options.

Magnetic resonance imaging (MRI)
An MRI machine uses radio waves and a strong magnetic field to produce detailed images of your brain. MRIs can reveal brain abnormalities that could be causing your seizures. Although the test is painless, some people experience an uncomfortable feeling similar to claustrophobia inside the MRI machine's close quarters. If you think you may have a problem like this, your doctor can prescribe anti-anxiety medications beforehand.

Functional MRI (fMRI) — a special type of MRI — can measure the small metabolic changes that occur when a part of your brain is working. An fMRI can record which areas of your brain are working when you perform certain tasks, such as rubbing a block of sandpaper or answering simple questions. Functional MRI is not routine, but done only in special cases where the location of certain functions is critical in understanding someone's seizures.

Positron emission tomography (PET)
PET scans use injected radioactive material to help visualize active areas of the brain. The radioactive material is tagged in a way that makes it attracted to glucose. Because the brain uses glucose for energy, the parts that aren't working normally will appear faint on a PET image. PET imaging is done only rarely in the evaluation of people with seizures.

Single-photon emission computerized tomography (SPECT)
This type of test is used primarily in people being evaluated for epilepsy surgery when the area of seizure onset is unclear on MRIs or EEGs. SPECT imaging requires two scans — one during a seizure and one during a nonseizure period. Radioactive material is injected for both scans and then the two results are compared. The image of the area of the brain with the greatest activity during the seizure can be superimposed onto the person's MRI, to show surgeons exactly what portion of the brain should be removed.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Some children outgrow temporal lobe seizures, but this is less likely if brain scans show a defect or scar where the seizures are originating. The defect or scar makes these seizures more difficult to control with medications, but it can also make the person a candidate for surgery.

Medications
Numerous medications are available to treat seizures, including:

• Carbamazepine (Tegretol)
• Phenytoin (Dilantin)
• Valproic acid (Depakene)
• Oxcarbazepine (Trileptal)
• Lamotrigine (Lamictal)
• Gabapentin (Neurontin)
• Topiramate (Topamax)
• Phenobarbital
• Zonisamide (Zonegran)
• Levetiracetam (Keppra)
• Tiagabine (Gabitril)
• Pregabalin (Lyrica)
• Felbamate (Felbatol)

However, many people don't achieve seizure control with medications alone. Possible side effects of anti-seizure medications include fatigue and dizziness.

Surgery
Surgery to remove the portion of the temporal lobe that's causing the seizures is often effective. Success rates range between about 65 percent to as high as 90 percent, depending on the cause of the temporal lobe seizures. Surgery is rarely an option if your seizures originate from a region of the brain that contains vital brain functions, and in cases where the seizures come from more than one area.

Before surgery, you'll need a comprehensive evaluation, with magnetic resonance imaging scans of your brain and, usually, observation of your seizures in a hospital-based monitoring unit using video recordings and EEG.

Researchers have been investigating the use of radiosurgery, which uses a gamma knife to deliver a precise dose of radiation to the damaged portion of the brain. This procedure is still considered experimental and the anti-seizure effects as well as the side effects aren't immediately apparent after the procedure, but instead become evident over time.

Although many people continue to need some medication to help prevent seizures after surgery, you may be able to take fewer drugs and reduce your dosages. In some cases, surgery for epilepsy can cause complications, such as permanently altering your cognitive abilities. Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering. You may also want to request a second opinion before undergoing surgery.

Vagus nerve stimulation
A device called a vagus nerve stimulator may be an option if medications are ineffective or cause serious side effects. The stimulator is implanted into your chest under the collarbone. Wires from the stimulator are attached to the vagus nerve in your neck. The device turns on and off according to an adjustable program, and can be activated with a magnet.

Pregnancy and seizures
Women who experience seizures can have healthy pregnancies. However, preconception planning is even more important for women who have seizures than it is for other women. By letting your doctor know that pregnancy is your goal, you can try to lower your seizure medication prior to pregnancy, and switch medications if necessary. The American Academy of Neurology recommends that women avoid using valproate during pregnancy because of risks to the baby. If your seizures can't be well-controlled with any other medication, discuss the potential risks with your doctor.

Contraception and anti-seizure medications
It's also important to know that some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if other forms of contraception need to be considered.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

If your temporal lobe seizures aren't well controlled, you may need to take special precautions to keep yourself and those around you safe. These precautions may include limiting activities such as swimming, driving, working at heights and operating heavy equipment and altering some routines, such as taking showers instead of baths. Some states have laws requiring such restrictions depending on how well you're able to control your seizures.

You might also consider wearing a medical bracelet to help emergency medical personnel. The bracelet should state whom to contact in an emergency, what medications you use and your medication allergies.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Even after they're under control, seizures can continue to affect your life. Temporal lobe seizures may present even more of a coping challenge because people may not recognize the unusual behavior as a seizure. Children may get teased or be embarrassed by their condition, and both children and adults may be frustrated by living with the constant threat of another seizure. Poor self-esteem, depression and suicide are increased in people who have repeated seizures. Most states restrict those who've had seizures from driving until they've gone a long time without a seizure. Even recreational activities can be affected, because you can't do certain activities, such as swimming, alone.

You may find it helpful to talk with other people who are in the same situation you are. Besides offering support, they may also have advice or tips for coping that you'd never considered. The Epilepsy Foundation has a network of support groups, as well as online forums for teens and adults who have seizures and for parents of children who have seizures. You can reach them at 800-332-1000 or visit the foundation Web site. You can also ask your doctor if he or she knows of any support groups in your area.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.