Extra temporal lobe epilepsies (ETLE) are characterized by the seizures arising from foci outside the temporal lobe. They can arise from following locations in the brain:
Frontal lobe ( located at the front of the head)
Parietal lobe (located at the top of the head)
Occipital lobe (located at the back of the head)
Hypothalamic hamartoma
Frontal Lobe Epilepsy (FLE)
Second most commonly found epilepsy in adults
Patients usually complains of non-specific, unexplainable feeling, often localized to the head
Asymmetric tonic seizures are often preceded by a somatosensory aura
Patient may experience autonomic auras like nausea or palpitations as well as emotional auras such as fear
Seizures are of significantly shorter duration and usually last less than 1 min
Consciousness is usually preserved in seizures
Parietal lobe epilepsy (PLE)
Accounts for a very small percentage of extra temporal epilepsies
Clinical manifestation of seizures is generally silent
Patient experience somatosensory auras that include
Paresthetic sensations like feeling of numbness, “pins and needles” sensation and an unpleasant crawling sensation
Dysesthetic sensations
Painful sensations
Occipital Lobe Epilepsy (OLE)
Account for 2-13% of extra temporal epilepsies
Signs and symptoms can be either due to discharge from the occipital lobe itself or due to discharge propagation outside occipital lobe
Visual hallucination is considered one of the hallmark of the occipital lobe seizures
Hypothalamic hamartoma Epilepsy
Characterized by gelastic seizures that are usually the first seizure type and occur very early in life
Seizures are usually very brief (duration < 20 s) and frequent (usually with multiple seizures per day) Diagnosis of extra temporal epilepsy
The diagnosis of epilepsy originating from extra temporal foci requires thorough clinical and neurological examination along with following diagnostic tests:
Magnetic Resonance Imaging (MRI)
Positron Emission Computed Tomography (PET)
Mapping of blood flow (ictal SPECT) during a seizure
Extra temporal Surgery
Extra temporal surgery using latest technology, including improving MRI, stereo taxis and microsurgery techniques is performed to treat most of the epileptic syndromes arising from extra temporal region.
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