Temporal Lobe Epilepsy (TLE)

Reviewed by: HU Medical Review Board

Temporal lobe epilepsy, or TLE, is the most common type of focal epilepsy. TLE affects about 6 out of every 10 people with focal epilepsy.1,2

In TLE, seizures start in a specific part of the brain. That part is called the temporal lobe. The temporal lobe is located just behind your ears. It helps you process:1,2

  • Sound
  • Visual information
  • Memories

What are the 2 types of TLE?

  • Mesial temporal lobe epilepsy (MTLE): MTLE affects the middle part of the temporal lobe. Seizures often start in or near a part of the brain called the hippocampus. Eight out of 10 cases of all temporal lobe seizures are linked to MTLE.1
  • Neocortical (lateral temporal lobe) epilepsy: Another type of TLE is neocortical epilepsy. This type affects the outer part of the temporal lobe.1

Who gets temporal lobe epilepsy, and why?

TLE can affect anyone of any age, but it is most common in those 10 to 20 years old.3

There are many causes of TLE, including:1-3

  • Brain injuries
  • Brain infections
  • Brain tumors
  • Blood vessel malformations
  • Problems with brain development

Febrile seizures are the most common risk factor for TLE. These seizures happen as a result of a high fever. Babies and children who have a seizure caused by a high fever for 15 minutes or longer are more likely to develop TLE later. But most people who have febrile seizures do not develop TLE.1,3

What types of seizures happen when you have TLE?

Seizures that occur in TLE include focal aware seizures and focal impaired awareness seizures.1

Focal aware seizures

A focal aware seizure is a seizure that starts in one area of the brain and stays in that area. Focal aware seizures may also be called "focal onset aware" or "simple partial" seizures. The person is awake and aware of what is happening. They may have uncontrolled movements, feelings, or sensations that last less than 2 minutes.1,4,5

Focal impaired awareness seizures

A focal impaired awareness seizure is a type of seizure where the person is not aware of what is happening around them. The person may have a blank look on their face or appear to be daydreaming. These seizures usually last 1 to 2 minutes. They also start in one area of the brain and stay there.1,4,6

How TLE is diagnosed

A doctor called a neurologist diagnoses and treats TLE. Neurologists are specially trained to diagnose and treat conditions of the brain, spinal cord, and nerves. The doctor will use tests including the following to help diagnose TLE.1,2

Electroencephalogram (EEG)

An EEG is a painless test used to find problems with the electrical activity in your brain. During an EEG, small metal discs with thin wires (electrodes) are placed on your scalp. The signals from the electrodes go to a computer, which records the results. Your doctor looks for abnormal patterns in the EEG results. These abnormal patterns indicate seizures and other problems.1,2,7

Video EEG

A video electroencephalogram (VEEG or EEG with video recording) might also be needed. A VEEG records what you are doing, saying, or feeling while also recording the electrical activity in your brain. The purpose is to see what happens when you have a seizure or event and compare it to the EEG recording. This way, your doctor can see if your seizure or event is related to the electrical activity in your brain.1,2,8

Magnetic resonance imaging (MRI)

An MRI is a painless test that uses magnets and radio waves to make detailed pictures of the body. An MRI is different from a computerized axial tomography (CAT) scan because it does not use radiation. Taking an MRI of your brain can help your doctor find the cause of your seizures.1,2,9

How temporal lobe epilepsy is treated

Treatment is available for TLE. Treatment focuses on controlling seizures and may include:1,2,10,11

  • Anti-seizure drugs – Most people with TLE get full seizure control when using anti-seizure drugs. About 1 in 3 people with TLE do not.
  • SurgerySurgery may be needed for those who do not respond to anti-seizure drugs. Options vary depending on your symptoms, history, and health. Talk to your doctor if this might be an option.
  • Vagus nerve stimulation (VNS)VNS uses a device that is implanted under your skin and sends electrical impulses to the vagus nerve. The vagus nerve runs from your brainstem to your belly. The electrical impulses help prevent seizures.
  • Responsive neurostimulation (RNS) – Like VNS, RNS uses an implanted device that sends electrical impulses. Unlike VNS, RNS sends the impulses to the area in the brain where your seizures are happening. This more targeted approach may also help prevent your seizures.

Possible outcomes for people with TLE

Most people with TLE can get their seizures under control and lead normal lives. In children with TLE, seizures may even disappear over time. People who have a harder time controlling their seizures may also have mood or memory problems. Treatment at an epilepsy center is usually recommended.1-3

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