Temporal lobe epilepsy

Epidemiology: most common form of epilepsy
- ∼ 40% of all epilepsy cases
- ∼ 70% of focal epilepsy cases
Etiology
- Hippocampal sclerosis: found in approx. 70% of patients suffering from temporal lobe epilepsy that is resistant to pharmacotherapy
  - Histopathology: atrophy of the hippocampal neurons with marked reactive gliosis (astrocyte proliferation in response to injury).
- Encephalitis (e.g., herpes simplex encephalitis)
- Developmental disorders
- Neurodegenerative disorders
- Tumors
Clinical features: Seizures commonly occur in clusters, last approx. 30 seconds to 2 minutes, and follow a specific sequence.
1. Aura
  - Visceral, olfactory, or auditory
  - Feelings of familiarity or unfamiliarity and “dreamy states”
2. Focal seizure with impaired awareness (complex partial seizure)
  - Motor symptoms
    - Typically oral alimentary automatisms (e.g., lip-smacking)
  - Autonomic symptoms
  - Altered mental status
    - Children appear absent-minded (e.g., staring ahead, unresponsive when spoken to)
    - No loss of consciousness
3. Postictal phase
  - Confusion and tiredness (common)
Diagnosis: EEG shows temporal lobe spikes

Frontal lobe epilepsy

Jacksonian March: A specific type of focal aware motor seizure where symptoms start in one area (e.g., thumb) and spread sequentially to adjacent areas (e.g., hand, arm), reflecting the seizure’s progression along the motor homunculus.