In temporal lobe seizures, the abnormal electrical activity of the brain that occurs during a seizure is confined to one or both of the brain's temporal lobes, which stretch from a person's temples to a point just in back of the ears on both sides of the brain. These seizures are described as being both "focal" and "complex partial" in nature. Focal describes the limited area within the brain to which the abnormal electrical activity is confined. Complex partial indicates both the limited spread of the abnormal activity at the onset of the seizure, and that while a person does not fully lose consciousness during the seizure, he does lose awareness of his surroundings as it is happening, and he does not remember what happened afterwards.
Aura
Often a temporal lobe seizure will begin with an aura, an odd sensation which can constitute a warning that a seizure is about to begin. The aura is itself a simple partial seizure--a seizure that has not yet gotten to the point of causing impaired consciousness. It may give a person time to get into a safe situation before the seizure spreads. Auras can take a number of forms.
Some indicators may precede the aura and seizure by several hours. A person may have a sleepless night, feel nauseous or have a headache. Or she may become depressed or irritable.
As the onset of the seizure approaches, she may suddenly become euphoric or fearful for no obvious reason. She could experience an unsettling sense of familiarity, or déjà vu, strange tastes or a rising sensation in her abdomen. She could have "phantosmia," an olfactory hallucination. On the Mayo Clinic site, neurolgist Jerry Swanson, M.D., states these sensory hallucinations may have any quality to them, from pleasant to foul.
For some, auras follow a predictable sequence. When these predictable patterns occur, it is thought that they may constitute clues to the specific neural pathways followed by the spreading abnormal electrical activity in the brain.
The Ictal State
A complex partial seizure with outward signs apparent to witnesses typically lasts from 30 seconds to two minutes.
A person in the ictal state may stare off into space with no actual awareness of what is going on around him. If other outward symptoms are mild, the casual observer may think he is just daydreaming. However, if someone tries to get his attention, he will not respond.
He may perform repetitious, purposeless motions known as automatisms (smacking lips or appear to be chewing or swallowing something repeatedly). He might perform purposeless movements with his fingers, hands, arms or legs.
Vocalizations are less common. A word, a phrase or meaningless sounds may be repeated. He may cry out or laugh. Hazardous behavior is also possible, such as walking or removing clothes with no awareness of the surroundings. He may resist help from well-meaning witnesses.
The Post-ictal State
In the immediate aftermath of a seizure, the person will typically be tired and confused. She may have a headache, not realize she had a seizure and may not remember what she was doing just prior to it. This is termed "post-ictal amnesia."
Over time, repeated temporal lobe seizures may lead to shrinkage in a part of the lobe called the hippocampus, resulting in permanent memory problems.
Mayo Clinic warns that if a person does not pull out of a seizure of this type within a few minutes, but instead develops jerky or rhythmic movements, she may be falling into a more serious tonic-clonic or "grand mal" seizure, which can result in convulsions and a full loss of consciousness.
