Temporal lobe seizures: symptoms and treatment

There is a temporal lobe on each side of the brain, roughly level with the ears. They are involved in memory, hearing and making sense of language. A seizure is a short burst of abnormal electrical activity. When it starts in one temporal lobe and stays on one side, it is a focal seizure arising there.

Epilepsy Action explains that focal seizures start on one side of the brain, and that about 6 in 10 people with epilepsy have focal seizures. Epilepsy is the usual name for a tendency to have repeated seizures. The NHS says a doctor will usually diagnose epilepsy after more than one seizure, or if tests show a risk of more.

People describe temporal lobe seizures in very different ways. Epilepsy Action lists feeling frightened, a feeling that what is happening has happened before, hearing things that are not there, an unpleasant taste or smell, and a rising sensation in the stomach. Skin colour or heart rate may change.

Others can sometimes see signs you cannot feel. These include lip smacking, repeated chewing or swallowing, and automatic behaviours such as fidgeting, undressing, walking or running. Afterwards you may feel confused or find it hard to speak for a short time. Epilepsy Action notes that wandering after a seizure is more likely with temporal lobe seizures, so someone should stay with you.

What many people call an aura is itself a small focal seizure. Epilepsy Action says some people use the word for a feeling before the main seizure, such as déjà vu or a strange smell. Sometimes the seizure spreads to both sides of the brain and becomes a tonic-clonic seizure, with stiffening and jerking.

• Sudden fear or a feeling of dread with no cause

• Intense déjà vu

• Odd smell or taste, often unpleasant

• Rising feeling in the stomach

• Staring, lip smacking, chewing or fumbling movements

• Confusion, tiredness or headache afterwards

The NHS says epilepsy happens when normal electrical activity in the brain changes. It is thought to be often related to inherited genes. It can also follow damage to the brain, for example after a head injury, a stroke or an infection. For many people the cause is never found.

Triggers differ from person to person and not everyone has them. The NHS suggests keeping a diary to spot patterns, naming tiredness, stress, periods, flashing lights, and certain foods or drinks as examples. Too much alcohol can increase the risk of seizures.

The first step after a possible seizure is a conversation. A specialist asks what happened before, during and after. A witness is valuable because you may not remember. Epilepsy Action suggests noting where and when it happened, what you were doing, how long it lasted and what it felt like.

The NHS lists tests that may follow: an EEG to check electrical activity, an ECG to check the heart, an MRI or CT scan, blood tests and sometimes genetic testing. The heart check matters because some blackouts are not seizures at all. A normal EEG does not rule out epilepsy, and an MRI may show a structural cause in some people.

The main treatment is anti-seizure medicine. The NHS says the one recommended depends on the type of seizures and factors such as age, sex and other conditions, and that you may need to try different ones. If you have been seizure-free for 2 years, a specialist may suggest gradually reducing the dose, but never change it yourself.

For most people medicines work well. Rarely, other options are used. The NHS names brain surgery, a small implanted device that stimulates the vagus nerve, and a specialist ketogenic diet.

Everyday safety measures help. The NHS suggests showers instead of baths where possible, care around cooking, tools and swimming, and carrying medical ID. Check-ups happen at least once a year. If you could become pregnant, talk to your specialist early, because some epilepsy medicines can harm a baby.

The NHS says epilepsy affects everyone differently. It can be lifelong or it can get better. For most people medicine works well and the effect on daily life is small. Others have seizures that are harder to control and need more support.

Seizures themselves are not usually harmful, although they can cause accidents or injury. Rarely a seizure goes on for a long time, called status epilepticus, which needs urgent treatment. There is also a small risk of sudden unexpected death in epilepsy, which treatment can reduce.

Epilepsy Action advises staying with the person, guiding them away from danger, staying calm and timing the seizure. Do not hold them down or give food or drink until they have recovered. Do not shout or make sudden movements. Explain afterwards what they missed.

Call 999 if it is their first seizure, if it lasts longer than usual for them or longer than 5 minutes, if they do not recover as usual, or if they have another seizure without recovering in between. The NHS adds three or more seizures in 24 hours. Someone who has had a possible first seizure and not gone to hospital should ask for an urgent GP appointment or call NHS 111.

After a first seizure the NHS route is usually urgent review by a specialist doctor, then tests and a care plan. Long-term follow-up is by your GP and a specialist team. Anti-seizure medicines are free if you hold a medical exemption certificate.

Some people also see a private neurologist for a faster EEG or MRI, or a second opinion on medicines. Surgery, where considered, follows specialist assessment. Whichever route you take, keep your seizure diary and a witness account for appointments.