Diagnosing Temporal Lobe Epilepsy in the Emergency Department: A Case Report

Temporal lobe epilepsy is a form of focal epilepsy that originates in the temporal lobes, often presenting with a variety of symptoms including altered consciousness, automatisms, and focal seizures with or without impaired awareness. Given such a diversity of manifesting symptoms, recognizing temporal lobe epilepsy in the emergency department (ED) can be challenging. Early identification is crucial for appropriate management, including timely initiation of antiepileptic therapy and differentiation from other neurological emergencies.

A 50-year-old male with no prior history of seizures or neurological conditions presented to the ED after experiencing unusual sensations that had begun three days earlier. The patient described an intermittent sensation of warmth rising from his pelvis to his head, accompanied by an experiential déjà vu-like feeling he described as "dream reenactment." His episodes had become progressively more frequent, occurring approximately once every 90 minutes within the first 24 hours, with two instances of brief loss of consciousness. Diagnostic workup, including neurology consultation and an electroencephalogram in the ED, revealed a 19-second, non-motor focal seizure originating from the left anterior temporal region, consistent with temporal lobe epilepsy. Magnetic resonance imaging showed no acute structural abnormalities. The patient was diagnosed with temporal lobe epilepsy, started on lacosamide, and discharged from the ED.

This case underscores the importance of recognizing temporal lobe epilepsy in the ED, particularly in patients with recurrent episodes of altered consciousness or unusual sensory experiences. Prompt diagnosis and treatment are critical to preventing further seizures and improving quality of life.