By: Iris Zhao
Temporal Lobe Epilepsy
What is Temporal Lobe Epilepsy?
Temporal lobe epilepsy (TLE) is a form of epilepsy in which seizures begin in the temporal lobes of the brain. TLE is the most common form of focal epilepsy, which describes a neurological disorder that is the result of recurrent seizures that originate from a localized region of the brain. The primary symptom of TLE is seizures, which are frequently preceded by an epileptic aura or sensation that one feels before the seizure occurs.
(Charuta & Klein, 2019; Cleveland Clinic, 2025)
Types of Temporal Lobe Epilepsy
TLE can be classified into two forms based on the origin of where the seizure occurs. Mesial temporal lobe epilepsy (MTLE) accounts for the majority of all temporal lobe seizures, with seizures originating in the hippocampus or near the hippocampus of the brain. Neocortical or lateral temporal lobe epilepsy are the second type of TLE where seizures begin in the outer section of the temporal lobe.
(Charuta & Klein, 2019; Cleveland Clinic, 2025)
Causes
Your neurons or nerve cells in your brain normally help to send and communicate electrical signals to different parts of your brain. However, TLE is caused when your neurons uncontrollably fire off signals instead of accurately directing signals to where they actually need to go, which causes the seizures. Often cited as the main factor for initiating seizures, psychological stress has recurrently been brought up as a frequent trigger for TLE.
(Charuta & Klein, 2019; Eggers, 2007; Cleveland Clinic, 2025)
Some other most common causes of TLE also includes the following:
- Hippocampal sclerosis (loss of neuron and glial cells in the hippocampus of the brain)
- Focal cortical dysplasia (when there is an abnormal collection of neurons in the brain)
- Brain tumors
- Traumatic brain injury
- Infections (e.g., meningitis)
- Vascular conditions (e.g., strokes)
- Genetic variants
- Unknown causes
(Cleveland Clinic, 2025)
Signs and Symptoms
Seizures in TLE often are characterized as focal aware seizures and focal impaired awareness seizures. TLE includes focal aware seizures, also known as epileptic auras, as the first symptoms of a seizure. Epileptic auras happen when one is awake and aware as the symptoms are occurring. That is then followed by the seizure itself.
Auras can sometimes be difficult to describe however, common symptoms of epileptic auras typically include:
- A feeling of familiarity (deja vu) or a feeling of unfamiliarity (jamais vu)
- A rising feeling of sickness coming from the stomach to the chest (this may feel like being on a roller coaster)
- Sudden feelings of fear, joy, panic, anxiety, or butterflies with nausea
- Stronger senses with hearing, sight, smell, taste or touch
An aura is considered to act as a warning before the seizure. It is important to note that not everyone experiences an epileptic aura before a temporal lobe seizure. Not everyone who has auras also remembers them. Although if an epileptic aura is experienced, they almost always last a few seconds to two minutes at most. An epileptic aura is the first thing that happens typically before a loss of consciousness.
Seizure symptoms will follow after an aura, where you may see the following signs:
- Loss of consciousness
- A blank stare
- A brief loss of your ability to speak or understand language (aphasia)
- Repetitive non-purposeful behaviors and movements (automatisms) of your hands (fidgeting, picking motions), eyes (excessive blinking) and mouth (lip-smacking, chewing, swallowing)
- Confusion
- Dilated pupils
- Not being aware of people or things around you
Although TLE seizures typically last from 30 seconds to 2 minutes, some people can also have prolonged seizures. These seizures that are rare, repeated or long seizures are called status epilepticus.
(Charuta & Klein, 2019; Cleveland Clinic, 2025; Mayo Clinic, 2025)
After a temporal lobe seizure, it is also normal to be confused and have difficulty speaking, be sleepy, be unable to recall what happened during the seizure or even remember having a seizure (Mayo Clinic, 2025).
Diagnosis
After a combination of reviewing your symptoms and medical history, obtaining a history of your seizure occurrences, performing a neurological exam, and ordering the necessary tests, your healthcare provider will come to the conclusion of diagnosing temporal lobe epilepsy. Sometimes, a patient may not remember what happened when having a seizure therefore, they may also bring along someone who was with them at the time of the seizure to the appointment.
Testing will help a healthcare provider determine whether someone has TLE by looking inside their brain. Some common tests that may be performed include an electroencephalogram (EEG), which helps indicate rhythmic slowing in the mesial (middle) temporal lobe areas during seizures that are otherwise more difficult to diagnose unless it is captured on the EEG. A magnetic resonance imaging (MRI) test may also likely be performed to look for changes and alterations in the temporal lobes.
(Charuta & Klein, 2019; Cleveland Clinic, 2025)
Treatment
There are different treatments for TLE including antiseizure medications, surgery for epilepsy, and types of neurostimulation devices.
Typically, the first line of treatment for TLE is the prescription of antiseizure medications (ASMs) for the purpose of controlling seizures. Healthcare providers usually try one or more medications and different dosages of the medications in order to find what works the best for the patient. However, for people who are pregnant, it’s important for them to consult their healthcare provider if they are or are planning to get pregnant as some ASMs may cause birth defects.
If ASMs are unsuccessful for the patient or if a brain tumor is what causes the epilepsy symptoms, healthcare providers will suggest surgery as a treatment for temporal lobe epilepsy. The most common surgery performed to treat temporal lobe epilepsy is a temporal lobectomy, where a part of the patient’s temporal lobe is surgically removed. Other less invasive procedures for treating temporal lobe epilepsy include stereotactic radiosurgery, which uses radiation, or laser ablation, which uses lasers, to destroy nerve cells or tissue in the section of the patient’s temporal lobe where their seizures begin. Finally, neurostimulation devices may be used to help treat temporal lobe epilepsy if both ASMs and surgery are not feasible or safe options for the patient with TLE.
Conclusion
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy, occurring when seizures begin in the temporal lobes of the brain due to abnormal electrical activity in neurons. It is often linked to causes such as hippocampal sclerosis, brain injury, tumors, infections, genetic factors, or sometimes unknown conditions. TLE seizures are often preceded by epileptic auras and may involve symptoms that may include having unusual sensations, repetitive movements, and altered awareness. Diagnosis typically includes reviewing a patient’s medical history and utilizing tests like EEGs and MRIs. Treatment options include antiseizure medications, surgical procedures, or neurostimulation devices to help control or reduce the seizures in TLE.
References
Cleveland Clinic. (2025). Temporal Lobe Epilepsy (TLE): Causes, Symptoms, and Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures
Charuta, J., Klein, H. (2019). Temporal Lobe Epilepsy (TLE). Epilepsy Foundation. https://www.epilepsy.com/what-is-epilepsy/syndromes/temporal-lobe-epilepsy
Eggers, A. E. (2007). Temporal Lobe Epilepsy is a disease of faulty neuronal resonators rather than oscillators, and all seizures are provoked, usually by stress. Medical Hypotheses, 69(6), 1284–1289. https://doi.org/10.1016/j.mehy.2007.03.025
Mayo Clinic. (2025). Temporal lobe seizure. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/symptoms-causes/syc-20378214
