Temporal lobe epilepsy starts in your temporal lobe. There are two temporal lobes, one on each side of your head above your temples. About 80% of all temporal lobe seizures start in or near your hippocampus. Medications can successfully control seizures in about 66% of people. Seizures that start near your hippocampus are usually successfully treated with surgery.
Temporal lobe epilepsy (TLE) is epilepsy that starts in the temporal lobe area of your brain. You have two temporal lobes, one on each side of your head behind your temples (by your ears and in alignment with your eyes).
TLE is the most common localized (also called “focal”) type of epilepsy. About 60% of people with focal epilepsy have TLE.
There are two types of TLE.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Your temporal lobe processes memories and sounds, interprets vision and governs speech and language. It’s also involved in some unconscious/automatic responses such as hunger, thirst, fight-or-flight, emotions and sexual arousal.
Your right and left temporal lobes differ in their functions. One or more functions may be affected depending on the exact location where the seizure starts in your temporal lobe. Right temporal lobe epilepsy may affect such functions as learning and memorizing nonverbal information (such as music and drawings), recognizing information and determining facial expressions. Your left temporal lobe is usually the dominant lobe in most people. Left temporal lobe epilepsy may affect your ability to understand language, learn, memorize, form speech and remember verbal information.
Anyone, of any race or sex, can develop epilepsy. Temporal lobe epilepsy usually begins between 10 and 20 years of age, although it can start at any age.
Factors that can lead to an increased risk of developing temporal lobe epilepsy (TLE) include:
Temporal lobe epilepsy is the most common seizure disorder, affecting about 50 million people worldwide. Temporal lobe epilepsy can account for about 40% of people with epilepsy seen in a busy epilepsy center.
Symptoms depend on how your seizure begins.
You may have an aura before a temporal lobe seizure. An aura is an unusual sensation that you feel before a seizure starts. Not everyone experiences an aura. An aura is a part of a focal aware seizure, meaning you’re awake and aware while the symptoms occur. They typically last from a few seconds to two minutes.
Sensations you may feel during an aura include:
Sometimes, temporal lobe seizures progress to another type of seizure, such as a focal impaired awareness seizure. During this seizure, you lose some degree of awareness for typically 30 seconds to 2 minutes.
Symptoms of focal impaired awareness seizures include:
In rare cases, a temporal lobe seizure can develop into a generalized tonic-clonic seizure. During a generalized tonic-clonic seizure, there’s stiffening and shaking of your entire body with loss of awareness. Sometimes, there’s loss of bladder control or biting of your tongue with these seizures. This seizure affects both sides of your brain and is also called a convulsion. It used to be known as a grand mal seizure.
Causes of temporal lobe epilepsy include:
Epilepsy can be life-threatening in a couple of situations:
Your healthcare provider will ask questions about your medical history and your seizures — how long they lasted; what you felt before, during and after the seizure; where you were and what happened before the seizure started; and if something seemed to trigger the seizure (examples of triggers include stress, lack of sleep, flashing lights, intense exercise and loud music). Your healthcare provider might also want to talk to people who were with you during a seizure to gather their observations. It can be helpful to have someone videotape your seizure to show your healthcare provider and to keep a diary of when your seizures occur.
Tests that are used in diagnosing temporal lobe epilepsy include:
Treatments for temporal lobe epilepsy include medications, diet, surgery, laser and electrical brain stimulator devices.
Many medications are available to treat temporal lobe seizures. Your healthcare provider might try one or more medications and different dosages over months to find the approach that’s best for you. Up to two-thirds of people with temporal lobe epilepsy have their seizures controlled with medications.
Because some antiseizure medications are linked to birth defects, let your healthcare provider know if you’re pregnant or planning to become pregnant.
Another treatment approach is a very specific change in diet. The ketogenic diet is a diet high in fat and very low in carbohydrates. It’s sometimes tried if medications aren’t successful in controlling your seizures.
Surgery is considered only after several attempts of medication have failed or a tumor or lesion responsible for the seizures has been identified. If an MRI shows hippocampal sclerosis in the medial temporal lobe and EEGs show seizure activity starts in that area, surgery may cure your seizures. Temporal lobectomy (removal of your temporal lobe) is the most common type of lobectomy and the most common surgery for epilepsy.
In this procedure, surgeons use magnetic resonance imaging (MRI) to guide the use of a laser. The laser is directed at scar tissue in the temporal lobe region that’s causing seizures. The laser uses heat to destroy the tissue that’s causing the seizures.
This surgery involves using 3D computerized imaging and precisely focused radiation beams to destroy the nerve cells that are misfiring and causing the seizures.
If two or more medications have not adequately controlled seizures and surgery isn’t an option, another option is nerve stimulation devices. These devices work in much the same way as a heart pacemaker monitors and respond to abnormal heart rhythms. There are three types of stimulators.
No medications or treatments can prevent epilepsy. However, because some seizures develop from other health events — for example, as a result of brain injuries, heart attacks and strokes — you can take some precautions to reduce your risk of developing seizures.
The more seizures you have and the longer you have them, the greater your risk of a decreased quality of life, depression, anxiety and memory impairment.
Medication is successful in controlling seizures in about two-thirds of people with temporal lobe epilepsy. For the other third, surgery helps about 70% become seizure-free.
Medication isn’t successful in controlling seizures in about 75% of people who have mesial temporal lobe epilepsy. However, 75% of these individuals are seizure-free following surgery.
If surgery doesn’t work or if you’re not a candidate for surgery, electrical brain stimulation devices can be tried.
If you’ve had a seizure or think you might’ve had a seizure, you should see your healthcare provider. If you have already been diagnosed with temporal lobe seizures, call your healthcare provider or seizure specialist if:
Stay with the person who is having the seizure and pay attention to exactly what is happening and how long it lasts. Don’t hold the person down, but try to keep them away from dangerous situations and move nearby objects out of the way. Speak calmly to the person who is having the seizure, during the seizure and afterward. Don’t put anything in their mouth. Do what you can to keep the person comfortable, during and after the seizure.
Call 911 if the seizure lasts longer than 5 minutes — or, if you’re familiar with the person’s seizure history, if the seizure lasts significantly longer than usual. If you think it’s their first seizure, call 911. Also call 911 if the person has another seizure right after the first one ends, is injured during the seizure, is having trouble breathing or asks you to get medical help.
A note from Cleveland Clinic
If you have temporal lobe epilepsy (TLE), becoming seizure-free is the goal. Seeing your healthcare provider at the first sign of seizures leads to early diagnosis, treatment and the best outcomes. Medications control seizures in most people with TLE. If you have mesial TLE, 75% of people become seizure-free after surgery. The key to the successful management of TLE is great communication between you and your healthcare provider. Make sure you understand all the benefits and risks of all your treatment options, the complications of uncontrolled seizures and possible adverse effects of medications. Ask your healthcare provider about support groups, too.
Last reviewed by a Cleveland Clinic medical professional on 12/07/2021.
Learn more about our editorial process.