TLE

Controversy Regarding Treatment of TLE

     Although certain methods have been found effective on patients with temporal lobe epilepsy, there has been some controversy on the issue of treatment itself. In some cases the controversy lies in the question of how much is too much?

     Temporal lobe resection is an operation performed on the brain in order to control seizures. Brain tissue in the temporal lobe is resected, or cut away, to remove the part of the brain that is causing the seizure. The anterior (front) and mesial (deep middle) portions of the temporal lobe are the areas most often involved in the resection. This is a method of treatment that has been used for years in order to treat epilepsy. The controversy over this treatment method is that the amount of brain to resect could be too much in some cases. There is always a question of how much resection is necessary in order to control a seizure.

     More controversy exists about how lesions are defined. One argument lies in whether recording of ictal activity or interictal data is necessary. "Ictal" implies a physiologic state or event such as a seizure, stroke or headache, whereas "interictal" implies the period of time between seizure or convulsion in epilepsy.

     In a study by the University of Bonn (1996), scientists' goal was to analyze the results of patients who were treated for temporal lobe epilepsy through surgical treatment. Series of tests resulted in a disagreement between both ictal and interictal methods; they are not easy to compare. One reason was that no seizures were recorded during the surgery, making it impossible to measure any data. Another reason was that the patients may have been inappropriately put in the group that were tested extraoperatively (outside of surgery) because the location of the lesion was not as clearly identified as in the patients who were tested intraoperatively (during surgery).

     More problems arise in the accuracy of treatments for temporal lobe epilepsy in the difficulty of getting data. A lot of mistakes occur in finding evidence that is necessary to have a reason to treat a patient. A clinical diagnosis could be incorrect because it is easy to get misleading reports or information from the patients themselves. There is also a lot of difficulty in a doctor actually seeing a seizure, especially at the time of the patient being tested. For example, EEG reports are not specific enough to show the connection between the exact location of a lesion and the overall effect of a psychological impairment. In general, many tests lead to errors, making doctors skeptical of the results.

Further Information on Treating TLE

      Many options exist for treating temporal lobe epilepsy, should one decide to do so. Though we did not explore the formal research regarding treatment, here are several reputable websites that discuss available treatment options for individuals with varying forms of temporal lobe epilepsy.


 

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