eMedicine Specialties > Neurology > Seizures and Epilepsy

Temporal Lobe Epilepsy: Follow-up

Author: David Y Ko, MD, Associate Professor, Department of Neurology, University of Southern California Keck School of Medicine
Coauthor(s): Soma Sahai-Srivastava, MD, Director of Neurology Ambulatory Care Services, LAC and USC Medical Center; Assistant Professor, Department of Neurology, University of Southern California
Contributor Information and Disclosures

Updated: Apr 8, 2009

Follow-up

Prognosis

  • Morbidity and mortality are increased compared with those in the general population due to increased accidents from the episodes of loss of consciousness. Mortality also occurs from sudden unexplained death in epilepsy (SUDEP). Patients with refractory temporal lobe epilepsy have an increased risk of sudden death that is 50 times greater than that in the general population. For more information, see the article Sudden Unexpected Death in Epilepsy. Epilepsy surgery seems to modify the risk of SUDEP if the patient remains seizure free. In patients who have undergone surgery, the mortality rate becomes equivalent to that of the general age- and sex-matched population.
  • Seizure-free state 2 years after anterior temporal lobectomy is predictive of long-term seizure-free outcome.
  • About 47-60% of patients become seizure free with medical treatment. After 3 first-line AEDs have failed, the chance for seizure freedom is 5-10%. Surgery in well-selected patients with refractory temporal lobe epilepsy yields a seizure-free outcome rate of 70-80%.
  • Patients with refractory temporal lobe epilepsy typically have material-specific deficits in memory function. Those patients with dominant temporal lobe epilepsy often have impaired language function as demonstrated by reduced naming ability on the Boston Naming Test.

Patient Education

For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education article Epilepsy.

Miscellaneous

Medicolegal Pitfalls

The most common medicolegal pitfall arises from the fact that different states in the United States have different rules regarding the physician's responsibility to report a patient with newly diagnosed epilepsy. For example, California state law mandates that the physician is responsible for reporting a patient with new-onset epilepsy to the Department of Motor Vehicles (DMV). If a doctor fails to report to DMV and the patient has an accident in which a third party is injured, the injured third party is able to sue the doctor for failure to report to the DMV and the DMV for failure to take away the patient's driver's license. Furthermore, even patients who report only simple partial seizures may have unrecognized complex partial seizures.

Special Concerns

Fetal anomalies due to antiepileptic medications: Physicians should carefully document on the chart that they have explained to their female patients with epilepsy about the increased risk of fetal anomalies associated with antiepileptic medications, a 2-fold increase (4-6%), and the increased risk of neural tube defects with valproate (1.5-2.0%) and carbamazepine (0.5%). Patients should be told that most women with epilepsy have healthy children (90-95%). They also should be told that the chance of a normal pregnancy outcome is increased with planned pregnancies, improved seizure control, folate supplementation (1-2 mg each day prior to pregnancy), minimizing the number of AEDs used, and never abruptly discontinuing AEDs without consulting the physician. Soon data from the Mass General AED pregnancy registry will be released, which will give some information about these medications.

 


More on Temporal Lobe Epilepsy

Overview: Temporal Lobe Epilepsy
Differential Diagnoses & Workup: Temporal Lobe Epilepsy
Treatment & Medication: Temporal Lobe Epilepsy
Follow-up: Temporal Lobe Epilepsy
References
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References

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Further Reading

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Keywords

temporal lobe epilepsy, psychomotor seizures, limbic seizures, TLE, aura, recurrent unprovoked seizures, simple partial seizures, complex partial seizures, uncinate fits, dreamy state, psychomotor epilepsy, hippocampal sclerosis, partial epilepsy, olfactory illusions, gustatory illusions, temporal lobe tumors, auditory hallucinations, neocortical TLE, visual illusions, micropsia, macropsia, vertigo, depersonalization, derealization, manual automatisms, unilateral dystonic posturing

oral alimentary automatisms, reactive automatisms, repetitive stereotyped manual automatisms, secondarily generalized tonic-clonic seizure, postictal period of confusion, postictal aphasia, amnesia, herpes encephalitis, bacterial meningitis, encephalomalacia, cortical scarring, hamartomas, gliomas, arteriovenous malformation, cavernous angioma, mesial temporal lobe epilepsy, MTLE, febrile seizures, complex febrile convulsions

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Contributor Information and Disclosures

Author

David Y Ko, MD, Associate Professor, Department of Neurology, University of Southern California Keck School of Medicine
David Y Ko, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Medical Association, and California Medical Association
Disclosure: Pfizer Honoraria Speaking and teaching; UCB Grant/research funds clinical trials; Johnson and Johnson Grant/research funds clinical trials

Coauthor(s)

Soma Sahai-Srivastava, MD, Director of Neurology Ambulatory Care Services, LAC and USC Medical Center; Assistant Professor, Department of Neurology, University of Southern California
Soma Sahai-Srivastava, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Erasmo A Passaro, MD, Director, Comprehensive Epilepsy Program/Clinical Neurophysiology Lab, Bayfront Medical Center Florida Center for Neurology
Erasmo A Passaro, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association, and American Society of Neuroimaging
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jose E Cavazos, MD, PhD, FAAN, Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center; Director of the Epilepsy Center, Audie L Murphy Veterans Affairs Medical Center
Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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