eMedicine Specialties > Neurology > Seizures and Epilepsy
Temporal Lobe Epilepsy: Treatment & Medication
Updated: Apr 8, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- About 47-60% of new-onset partial seizures are controlled effectively by the first drug. Studies in 1985 and 1992 by the Department of Veterans Affairs (VA) have shown that the 4 major antiepileptic drugs (AEDs), phenytoin, phenobarbital, carbamazepine, and valproate, are equally effective in controlling partial seizures; however, phenobarbital has more severe adverse effects.
- The newer AEDs, such gabapentin, topiramate, lamotrigine, levetiracetam, oxcarbazepine, and zonisamide have similar efficacy than the older AEDs but standout predominantly in having much less side effects both in day-to-day use as well as in long-term side effects. In 2005, pregabalin became the latest drug available.
- In patients with newly diagnosed epilepsy, oxcarbazepine appears to be significantly better than carbamazepine in terms of tolerability and health-related quality of life issues. The newer drugs are easier to use in terms of having much less drug-drug interactions than the older AEDs.
- About 40% of patients continue to have seizures in spite of trials with 3 AEDs. Semah and colleagues showed that seizures are more likely to be refractory to AEDs in patients with hippocampal sclerosis.17
Surgical Care
- Vagus nerve stimulation
- Vagus nerve stimulation (VNS) was approved by the FDA in 1997 for treatment of intractable partial epilepsy for patients aged 12 years and older. VNS with a high-frequency stimulation rate resulted in a mean reduction in seizure frequency of 25-28% at 3 months but improves to about 40% by year one. The exact mechanism by which it exerts its antiepileptic effect is not known. A battery-operated stimulator device is implanted in the chest and an electrode is attached to left vagus nerve in the neck.
- Adverse effects include hoarseness of voice, cough, local pain, paresthesias, dysphagia, and dyspnea when the device is on and almost none when the device is off, but the settings can be titrated so side effects can be minimized. VNS does not have the adverse effects associated with AEDs and is used adjunctively with AEDs.
- Anterior temporal lobectomy
- Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy (see article Identification of Potential Epilepsy Surgery Candidates). When seizures are not controlled by 2 different AED trials, the patient should be considered for a presurgical evaluation. These patients are not likely to achieve seizure control with medications alone (5-10% chance of becoming seizure free).
- The presence of unilateral hippocampal sclerosis and concordant EEG findings predict seizure-free outcome in patients considered for surgery. Foldvary and colleagues showed that a higher monthly preoperative seizure frequency is associated with a less favorable surgical outcome (see article Outcome of Epilepsy Surgery).5
- An extensive presurgical assessment for the feasibility of surgery is essential. This includes MRI, interictal and ictal EEG, neuropsychological testing, and the intracarotid amobarbital test called the Wada test.
- Seizure-free state at 2 years postoperatively is predictive of long-term seizure-free outcome. In well-selected cases, 70-80% of patients with refractory temporal lobe epilepsy become seizure free after surgery (see article Outcome of Epilepsy Surgery).
Medication
Until a few years ago, 4 principal medications were used for partial seizures: phenytoin, carbamazepine, valproate, and phenobarbital. In recent years, a number of newer medications have been approved by the FDA. Some of these newer AEDs are approved as monotherapy, but how they compare to the older AEDs is not known. The initial choice of medication depends on many factors including side effect profile and dosage schedule and comorbid conditions. The major VA trials did not show any significant difference in seizure control among the 4 older AEDs. Adverse effects were greater with phenobarbital and with primidone.
Single-drug therapy is the goal, and the dosage of each medication prescribed should be increased until either seizures are controlled or adverse effects occur.
Rufinamide (Banzel), a new anticonvulsant, was recently approved as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome.
Anticonvulsants
These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.
Carbamazepine (Tegretol, Carbatrol, Epitol)
Affects sodium channels during sustained rapid repetitive firing.
Extended release form preferred (Tegretol XR or Carbatrol) because of bid dosing, which improves compliance and leads to more stable blood levels. No IV formulation available.
Adult
600-2000 mg/d PO
Pediatric
5 mg/kg/d PO initially, followed by maintenance dose of 15-20 mg/kg/d
Danazol may increase serum levels significantly within 30 d; do not coadminister with MAOIs; cimetidine and erythromycin may increase toxicity; may decrease primidone and phenobarbital levels (their coadministration may increase carbamazepine levels); CBZ can decrease efficacy of oral contraceptive pills
Documented hypersensitivity; concurrent MAOIs
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Obtain CBCs and serum iron baseline prior to treatment, during first 2 mo, and yearly or every other year thereafter; can cause drowsiness, dizziness, and blurred vision; caution while driving or performing other tasks requiring alertness; long-term use has been associated with osteopenia. In patients with Asian ancestry a recent alert recommends checking for HLA B-1502 before starting CBZ because of the risk of rash.
Phenytoin (Dilantin)
One of oldest drugs known for treatment of seizures. In young women, can coarsen facial features and can cause hirsutism and gingival hyperplasia. In addition, requires frequent blood level determinations because of nonlinear pharmacokinetics. Long-term use associated with peripheral neuropathy and osteopenia.
Adult
Loading dose: 15-20 mg/kg/d PO/IV at rate no faster than 50 mg/min
Can be mixed only with isotonic saline since D5W causes phenytoin to precipitate fosphenytoin (prodrug of phenytoin) measured in units of phenytoin equivalents (PE; fosphenytoin can be diluted with either saline or D5W)
Maintenance: 3-5 mg/kg/d PO/IV
Fosphenytoin loading dose: 20 mg PE/kg infused IV at maximal rate of 150 mg/min
Pediatric
Initial dose: 5-7 mg/kg/d PO/IV
Maintenance: 5-7 mg/kg/d PO/IV
Amiodarone, benzodiazepines, chloramphenicol, cimetidine, fluconazole, isoniazid, metronidazole, miconazole, phenylbutazone, succinimides, sulfonamides, omeprazole, phenacemide, disulfiram, ethanol (acute ingestion), trimethoprim, and valproic acid may increase toxicity
Barbiturates, diazoxide, ethanol (chronic ingestion), rifampin, antacids, charcoal, carbamazepine, theophylline, and sucralfate may decrease effects
May decrease effects of acetaminophen, corticosteroids, dicumarol, disopyramide, doxycycline, estrogens, haloperidol, amiodarone, carbamazepine, cardiac glycosides, quinidine, theophylline, methadone, metyrapone, mexiletine, oral contraceptives, valproic acid
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Perform blood counts and urinalyses when therapy is begun and at monthly intervals for several months thereafter to monitor for blood dyscrasias; discontinue use if skin rash appears and do not resume use if rash is exfoliative, bullous, or purpuric; rapid IV infusion may result in death from cardiac arrest, marked by QRS widening; caution in acute intermittent porphyria and diabetes (may elevate blood glucose); discontinue use if hepatic dysfunction occurs
Valproate (Depacon, Depakene, Depakote, Depakote ER)
Anticonvulsant effective for broad spectrum of seizure types, believed to exert anticonvulsant effect by increasing GABA levels in brain. Approved for monotherapy or adjunctive therapy for partial seizures and generalized tonic-clonic seizures. Depakene capsule or syrup, Depakote tablet or sprinkle.
Adult
10-15 mg/kg/d IV initially at rate of 20 mg/min; increase by 5-20 mg/kg/wk to maximum 60 mg/kg/d or as tolerated
(Depakote ER the once-a-day formulation is not bioequivalent to Depakote DR, so adjustment requires 8-20% more on conversion, but levels can be checked.)
Pediatric
20 mg/kg/d IV initially followed by maintenance dose of 20-40 mg/kg/d
Cimetidine, salicylates, felbamate, and erythromycin may increase toxicity; rifampin may significantly reduce levels; in children, salicylates decrease protein binding and metabolism; may result in variable changes of carbamazepine concentration with possible loss of seizure control; may increase diazepam and ethosuximide toxicity (monitor closely); may increase phenobarbital and phenytoin levels, while either may decrease valproate levels; may displace warfarin from protein-binding sites (monitor coagulation tests); may increase zidovudine levels in HIV-seropositive patients
Documented hypersensitivity; hepatic disease/dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Thrombocytopenia and abnormal coagulation parameters have occurred; risk of thrombocytopenia increases significantly at total trough valproate plasma concentrations >110 mcg/mL in females and >135 mcg/mL in males; at periodic intervals and prior to surgery, determine platelet counts and bleeding time before initiating therapy; reduce dose or discontinue therapy if hemorrhage, bruising, or hemostasis/coagulation disorder occurs; hyperammonemia may occur, resulting in hepatotoxicity; monitor patients closely for appearance of malaise, weakness, facial edema, anorexia, jaundice, and vomiting; may cause drowsiness
Phenobarbital (Barbita, Luminal, Solfoton)
One of first major AEDs, introduced in 1919. FDA approved for initial or adjunctive therapy for partial-onset seizures. Has major cognitive adverse effects, which have limited its use in favor of newer AEDs that have better side-effect profiles. Long-term use has been associated with osteopenia.
Adult
90 mg PO qd initially; increase by 30 mg/d every mo to usual maintenance dose of 90-120 mg/d
Pediatric
3-5 mg/kg/d PO initially, followed by maintenance dose of 3-5 mg/kg/d
May decrease effects of chloramphenicol, digoxin, corticosteroids, carbamazepine, theophylline, verapamil, metronidazole, and anticoagulants (patients stabilized on anticoagulants may require dosage adjustments if added to or withdrawn from their regimen); alcohol may produce additive CNS effects and death; chloramphenicol, valproic acid, and MAOIs may increase toxicity; rifampin may decrease effects; induction of microsomal enzymes may result in decreased effects of oral contraceptives in women (must use additional contraceptive methods to prevent unwanted pregnancy; menstrual irregularities may also occur)
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
In prolonged therapy, evaluate hematopoietic, renal, hepatic, and other organ systems; caution in fever, hyperthyroidism, diabetes mellitus, and severe anemia since adverse reactions can occur; caution in myasthenia gravis and myxedema
Lamotrigine (Lamictal)
Newer AED approved as adjunctive therapy and crossover monotherapy for partial seizures. Also blocks sodium channels during sustained rapid repetitive neuronal firing. FDA approved for children younger than 16 years only for Lennox-Gastaut syndrome; not FDA approved for children with partial seizures because of increased incidence of rash.
Adult
Weeks 1 and 2: 50 mg/d PO; if given as adjunctive therapy with valproic acid, then 25 mg qod
Weeks 3 and 4: 100 mg/d PO in divided doses; if given as adjunctive therapy with valproic acid, then 25 mg/d, increase by 100 mg/d PO every wk; if coadministered with valproic acid, increase by 25-50 mg PO every other wk
Maintenance dose: 300-500 mg/d PO in divided doses; if coadministered with valproic acid, 100-200 mg/d
Pediatric
Initial dose: 1-2 mg/kg PO
Maintenance dose: 5-10 mg/kg PO
Acetaminophen increases renal clearance, decreasing effects; similarly, phenobarbital and phenytoin increase metabolism, decreasing levels; valproic acid increases half-life significantly to 63 h; lamotrigine has no effect on oral contraceptives pill (OCP), but OCPs decrease levels of lamotrigine (7 days without active hormonal medication lamotrigine levels can rise as much as 40%)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Incidence of severe rash is 1% in pediatric and 0.3% in adult patients; almost all cases occur within 2-8 wk of treatment; incidence of rashes of all types is 3.3% in monotherapy and with adjunctive therapy with enzyme-inducing AEDs (eg, phenytoin, carbamazepine); with enzyme-inhibiting AEDS (eg, valproate), incidence of rash is 10%; risk of rash reduced with slow titration; severe rash can develop into Stevens-Johnson syndrome
Gabapentin (Neurontin)
Approved by FDA as adjunctive therapy for partial seizures. Structurally related to GABA but does not affect GABA directly, although it is thought to modulate calcium channel.
Adult
Start at 300 or 400 mg PO tid and increase prn not to exceed 4800 mg/d
Usual minimum effective dose for partial seizures as an adjunct is 1200 mg; if CrCl 30-60 mL/min, 300 mg PO bid; if CrCl 15-30 mL/min, 300 mg PO qd
Hemodialysis patients: 200-300 mg after every hemodialysis
Pediatric
4-13 mg/kg/d PO initially
Maintenance: 10-50 mg/kg/d PO
Antacids may reduce bioavailability significantly (administer at least 2 h following antacids); may increase norethindrone levels significantly. Absorbed through the amino acid transport system, which is saturable.
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in severe renal disease; dizziness or somnolence may occur when starting therapy, so patients should be warned not to drive or operate heavy machinery during initial phase of treatment
Topiramate (Topamax)
Approved by FDA as monotherapy or adjunctive therapy for partial seizures and symptomatic generalized seizures. Exerts action by 4 mechanisms: sodium channel blockade, enhancement of GABA activity, antagonism of AMPA/kainate-type glutamate excitatory receptors, and weak inhibition of carbonic anhydrase.
Adult
400 mg PO qd in 2 divided doses; initial starting dose 25 mg/d with gradual increase of 25 mg/wk
Therapeutic response may be observed at dose of 200 mg/d; if renal CrCl <70 mL/min, then reduce dose by half
Pediatric
1-9 mg/kg/d PO
Phenytoin, carbamazepine, and valproic acid can significantly decrease levels; carbonic anhydrase inhibitors may increase risk of renal stone formation; use with extreme caution when administering concurrently with CNS depressants since may have additive effect in CNS depression, as well as other cognitive or neuropsychiatric adverse events; has dose-related effect on oral contraceptives efficacy above 200 mg/d
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
1.5% of patients develop kidney stones, because is weak carbonic anhydrase inhibitor; can cause metabolic acidosis and serum bicarbonate may be measured in those who may be symptomatic
Tiagabine (Gabitril)
Enhances GABA activity by inhibiting uptake in neurons and astrocytes. Can be used as add-on therapy for partial seizures. Has been known to exacerbate seizures with spike wave stupor. Recently, some patients who were receiving off label and never had seizures had seizures induced with tiagabine when used with another medication, which lowers the seizure threshold.
Adult
4 mg PO qd to start, increase by 4-8 mg/d every wk to maintenance dose of 32-56 mg in 2-4 divided doses
Pediatric
Not established
Cleared more rapidly in patients treated with carbamazepine, phenytoin, primidone, or phenobarbital than in patients who have not received one of these drugs
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Patients receiving valproate monotherapy may require lower doses or slower dose titration for clinical response; has caused moderately severe to incapacitating generalized weakness in as many as 1% of patients with epilepsy; weakness may resolve after reduction in dose or discontinuation of tiagabine; should be withdrawn slowly to reduce potential for increased seizure frequency
Zonisamide (Zonegran)
Approved in United States for adjunctive use for partial seizure. Has been studied extensively in Japanese and European trials for primary generalized seizures. Blocks T-type calcium currents and prolongs sodium-channel inactivation. Also weak carbonic anhydrase inhibitor. In monotherapy, has long half-life of 70 h.
Adult
100 mg PO qd initially for 2 wk, then increase by 100 mg/d qwk to q2wk to maintenance dose of 100-300 mg bid
Pediatric
Not established
May increase serum carbamazepine levels; carbamazepine may increase concentrations; phenobarbital may decrease levels
Documented hypersensitivity; history of urolithiasis
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Administration associated with 2-3.5% risk of urolithiasis; anorexia, nausea, ataxia, impaired concentration, and other cognitive side effects have been reported; cleared by hepatic conjugation and oxidation; therefore, dose should be reduced in patients with hepatic insufficiency
Oxcarbazepine (Trileptal)
Approved by FDA as monotherapy and adjunctive therapy for partial epilepsy in adults and children aged 2-16 years. Blocks sodium-activated channels during sustained rapid repetitive firing. Oxcarbazepine has antiepileptic activity, but its monohydroxy (MHD) metabolite is the most active compound. Different than carbamazepine, which generates 10-11 epoxide metabolite.
Adult
300 mg PO initially bid; increase by 300 mg bid qwk to maintenance of 600-1200 mg bid
Pediatric
Start with 8-10 mg/kg/d given bid and titrate to 18.5 to 48 mg/kg/d; not to exceed 2100 mg/d
May decrease levels of dihydropyridine calcium antagonists and oral contraceptives; can reduce serum concentrations of carbamazepine, phenobarbital, phenytoin, and valproic acid; when given in doses >1200 mg/d, may increase phenytoin and phenobarbital serum concentrations significantly; can reduce serum concentrations of oral contraceptives and make oral contraceptives ineffective; can increase clearance of felodipine
Documented hypersensitivity; hypersensitivity to carbamazepine (25-30% have cross-sensitivity)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Among persons with hypersensitivity to carbamazepine, 25-30% will have hypersensitivity to oxcarbazepine; can cause cognitive adverse effects such as psychomotor slowing, impaired concentration, impaired speech and impaired language; in persons with impaired renal function (CrCl <30 mL/min), dose should begin at half usual starting dose, and dose increments should be made more slowly; can cause hyponatremia (sodium <125 mmol/L); rapid withdrawal can cause exacerbation of seizures; observe for adverse effects and monitor plasma levels of concomitant anticonvulsants during dose titration
Levetiracetam (Keppra)
Approved by FDA in 1999 as add-on therapy for partial seizures. Also FDA approved as add-on therapy for juvenile myoclonic epilepsy and primary generalized tonic clonic seizures. Mechanism of action is thought to be related to its binding to presynaptic vesicle protein. Has favorable adverse effect profile overall except for behavioral changes.
Adult
500 mg PO bid initially; increase by 500 mg PO bid q2wk; not to exceed 1500 mg PO bid in adults; lower doses recommended in elderly (start at 250 mg PO bid) and in patients with renal impairment. There is also an oral solution and IV formulation
Pediatric
Recommended starting dose is 20 mg/kg PO divided bid and can be increased over time to 60 mg/kg
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Renally excreted (67%) and, thus, dose should be lowered in renal impairment; major side effects include somnolence, asthenia, incoordination, mild leukopenia (3%), and behavioral changes such as anxiety, hostility, emotional lability, depression and psychosis (1-2%), and depersonalization
Felbamate (Felbatol)
Approved for medically refractory partial seizures and Lennox-Gastaut syndrome. Has multiple mechanisms of action, including blockade of glycine site of NMDA receptor, potentiation of GABAergic activity, and inhibition of voltage-sensitive sodium channels. High rate of life-threatening side effects, so benefit risk needs to be carefully addressed.
Adult
600 mg PO tid initially; increase by 600-1200 mg/d qwk; not to exceed 1200-1600 mg PO tid
Pediatric
Not established
May increase steady-state phenytoin levels—40% dose-reduction of phenytoin may be necessary in some patients; phenytoin may double clearance, resulting in more than 45% decrease in steady-state levels; phenobarbital may cause increase in phenobarbital plasma concentrations; phenobarbital may reduce plasma levels; may decrease steady-state carbamazepine levels and increase steady-state carbamazepine metabolite levels; may increase steady-state valproic acid levels
Documented hypersensitivity; blood dyscrasias; hepatic dysfunction
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Associated with marked increase in incidence of aplastic anemia (monitor CBC periodically); marked increase in fatal hepatic failure reported in patients receiving felbamate; perform liver function testing (ALT, AST, bilirubin) before therapy and at 1- to 2-wk intervals during therapy; discontinue immediately if liver abnormalities detected during treatment
Pregabalin (Lyrica)
A new medication approved in 2005 for adjunctive use in partial seizures in adults. Has similar mechanism as gabapentin by modulating calcium channel but is more potent and has linear pharmacokinetics.
Adult
75 mg PO bid or 50 mg PO tid initially; if needed, may increase dose to maximum of 600 mg/d
Pediatric
Not established
May cause additive effects on cognitive and gross motor functioning when coadministered with drugs that cause dizziness or somnolence
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue gradually (over a minimum of 1 wk) to minimize increased seizure frequency in patients with seizure disorders; may cause insomnia, nausea, headache, or diarrhea with abrupt withdrawal; common adverse effects include dizziness, somnolence, blurred vision, weight gain, and peripheral edema; may elevate creatinine kinase level, decrease platelet count, and increase PR interval; doses >300 mg/d associated with higher rate of adverse effects and treatment discontinuation; decrease dose with renal impairment (ie, CrCl <60 mL/min)
Rufinamide (Banzel)
Antiepileptic agent. Structurally unrelated to current antiepileptics. Modulates sodium channel activity, particularly prolongation of the channel's inactive state. Significantly slows sodium channel recovery and limits sustained repetitive firing of sodium-dependent action potentials. Indicated for adjunctive treatment of seizures associated with Lennox-Gastaut syndrome.
Adult
400-800 mg/d PO divided bid initially; increase in 400-800-mg/d increments q2d; not to exceed 3200 mg/d; administer with food
Adding to valproate: Initiate at dose <400 mg/d PO divided bid
Pediatric
<4 years: Not established
>4 years: 10 mg/kg/d PO divided bid initially, may increase in 10-mg/kg increments qod; not to exceed 45 mg/kg/d or 3200 mg/d; administer with food
Weak inhibitor of CYP2E1 and weak inducer of CYP3A4; serum levels may decrease when coadministered with carbamazepine, phenobarbital, phenytoin, and primidone; serum levels may increase when coadministered with valproate (if on valproate, initiate rufinamide therapy at dose <400 mg/d); conversely, concurrent use can decrease carbamazepine and lamotrigine serum levels and increase serum levels of phenobarbital and phenytoin (because of nonlinear kinetics); may decrease serum levels of ethinyl estradiol and norethindrone when coadministered (oral contraception users should use additional nonhormonal contraception); decreases AUC and Cmax of triazolam
Documented hypersensitivity; history of familial short QT syndrome; severe hepatic impairment
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May shorten QT interval; may cause multiorgan hypersensitivity reaction; withdrawal; status epilepticus; caution with mild-to-moderate hepatic impairment; common adverse effects include somnolence, fatigue, dizziness, ataxia, nausea, vomiting, and headache; like other antiepileptic drugs, discontinue gradually; monitor for emergence or worsening of depression, suicidal thoughts, or suicidal behavior
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 |
| « Previous Page | Next Page » |
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Further Reading
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
