Estudios transversales han sugerido que este trastorno cognitivo puede ser progresivo pero serian necesarios estudios longitudinales a largo plazo para poder comprobarlo. Pruebas complementarias. Actividad epileptiforme constituida por punta, punta-onda u onda aguda unilateral en electrodos temporales anteriores. Sanchez-Alvarez et al,
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Types[ edit ] Over forty types of epilepsy are recognized and these are divided into two main groups: focal seizures and generalized seizures. In , the ILAE recognized three types of seizures occurring in temporal lobe epilepsy. The classification was based on EEG findings.
The newer classification gives two types of focal onset seizures, as focal aware and focal impaired awareness. Visual distortions such as macropsia and micropsia Dissociation or derealisation Synesthesia stimulation of one sense experienced in a second sense may transpire.
Often, the patient cannot describe the sensations. Regardless, an aura is actually a seizure itself, and such a focal seizure may or may not progress to a focal impaired awareness seizure. They usually begin with a focal aware seizure, then spread to a larger portion of the temporal lobe, resulting in impaired consciousness. They may include autonomic and psychic features present in focal aware seizures.
Signs may include:  Automatic movements of the hands or mouth Confusion and disorientation Altered ability to respond to others, unusual speech Transient aphasia losing ability to speak, read, or comprehend spoken word These seizures tend to have a warning or aura before they occur, and when they occur they generally tend to last only 1—2 minutes.
It is not uncommon for an individual to be tired or confused for up to 15 minutes after a seizure has occurred, although postictal confusion can last for hours or even days.
Though they may not seem harmful, due to the fact that the individual does not normally seize, they can be extremely harmful if the individual is left alone around dangerous objects. For example, if a person with complex partial seizures is driving alone, this can cause them to run into the ditch, or worse, cause an accident involving multiple people.
With this type, some people do not even realize they are having a seizure and most of the time their memory from right before or after the seizure is wiped.
First-aid is only required if there has been an injury or if this is the first time a person has had a seizure. Focal to bilateral seizures or generalized seizures[ edit ] Seizures which begin in the temporal lobe, and then spread to involve both sides of the brain are termed focal to bilateral. Where both sides of the brain or the whole brain are involved from the onset.
These were previously known as grand mal seizures. This is the postictal state. The degree and length of postictal impairment directly correlates with the severity of the seizure type. Focal aware seizures often last less than sixty seconds; focal with impaired awareness seizures may last up to two minutes; and generalized tonic clonic seizures may last up to three minutes. Because a major function of the temporal lobe is short-term memory, a focal with impaired awareness seizure, and a focal to bilateral seizure can cause amnesia for the period of the seizure, meaning that the seizure may not be remembered.
Although the psychosocial impacts of epilepsy may be causative, there are also links in the phenomenology and neurobiology of TLE and depression. Declarative memory memories which can be consciously recalled is formed in the area of the hippocampus called the dentate gyrus. Animal models and clinical studies show that memory loss correlates with temporal lobe neuronal loss in temporal lobe epilepsy. Verbal memory deficit correlates with pyramidal cell loss in TLE. This is more so on the left in verbal memory loss.
Neuronal loss on the right is more prominent in non-verbal visuospatial memory loss. The finding of a lesion such as hippocampal sclerosis a scar in the hippocampus , tumour, or dysplasia , on magnetic resonance imaging MRI predicts the intractability of seizures.
Personality and behavioural change in temporal lobe epilepsy is seen as a chronic condition when it persists for more than three months. Documented by Norman Geschwind , signs include: hypergraphia compulsion to write or draw excessively , hyperreligiosity intense religious or philosophical experiences or interests , hyposexuality reduced sexual interest or drive , circumstantiality result of a non-linear thought pattern, talks at length about irrelevant and trivial details.
Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality. However, although the virus is found in temporal lobe tissue at surgery for TLE, it has not been recognised as a major factor in febrile seizures or TLE. It is unknown whether changes in reelin expression play a role in epilepsy. In animal models, neuronal loss occurs during seizures but in humans, neuronal loss predates the first seizure and does not necessarily continue with seizure activity.
Loss of mossy cells lowers the threshold of action potentials of the granule cells. It has been found that GABA reversal potential is depolarising  in the subpopulation of the pyramidal cells due to the lack of KCC2 co-transporter. It has been shown that it is theoretically possible to generate seizures in the neural networks due to down-regulation of KCC2,  consistent with the chloride measurements during the transition to seizure  and KCC2 blockade experiments.
For instance, if the dendrites of granule cells reconnect, it may be in a way through the laminar planes that allows hyperexcitability. They project into the hilus of the dentate gyrus and stratum lucidum in the CA3 region giving inputs to both excitatory and inhibitory neurons. This is an example of synaptic reorganization.
This was noted in human tissue in and in animal models in In TLE, the sprouting mossy fibres are larger than in the normal brain and their connections may be aberrant.
Mossy fibre sprouting continues from one week to two months after injury. This is evident in intracellular recordings. Also, in animal models, granule cell hyper-excitability is recorded before aberrant mossy fibre sprouting has occurred.
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