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|Name = Temporal lobe epilepsy
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L<nowiki>'</nowiki>'''epilessia del lobo temporale''' è una forma di [[epilessia focale]], una condizione [[Neurologia|neurologica]] cronica caratterizzata spesso da [[crisi epilettiche]] diurne e/o notturne che possono essere silenti o tramutarsi in crisi generalizzate spesso accompagnate da [[convulsioni]] ([[crisi tonico-clonica]]). Sono conosciuti più di 40 tipi di epilessia. <ref name="ReferenceA">{{cite journal |doi=10.1046/j.152a8-1157.2001.10401.x |author=Engel J |author2=International League Against Epilepsy (ILAE) |title=A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology |journal=Epilepsia |volume=42 |issue=6 |pages=796–803 |year=2001 |month=June |pmid=11422340 |url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0013-9580&date=2001&volume=42&issue=6&spage=796}}</ref> Le crisi epilettiche vengono classificate in due categorie principali: [[crisi parziali]] (focali o localizzate) e [[crisi generalizzate]]. Le epilessie ad insorgenza parziale sono circa il 60% di tutti i casi di epilessia dell'adulto, e l'epilessia del [[lobo temporale]] (con sigla TLE dall'inglese "temporal lobe epilepsy") è la forma più comune di epilessia refrattaria ai farmaci.<ref name="PMID10830320">{{cite journal |author=Wiebe S |title=Epidemiology of temporal lobe epilepsy |journal=Can J Neurol Sci |volume=27 |issue=Suppl 1|pages=S6–10; discussion S20–1 |year=2000 |month=May |pmid=10830320 }}</ref>
Le epilessie del lobo temporale sono un gruppo di malattie nelle quali si hanno attacchi epilettici, spesso ricorrenti che derivano da uno o da entrambi i [[Lobo temporale|lobi temporali]] del cervello. I due tipi principali sono stati riconosciuti internazionalmente secondo la International League Against Epilepsy.<ref name="ReferenceA"/>
* '''Epilessia del lobo temporale mediale''' (MTLE, acronimo inglese di "medial temporal lobe epilepsy") <!--improprio utilizzare "mesiale" che si riferisce alle facce dei lobi occipitale, parietale e frontale adiacenti alla scissura inter-emisferica e all'insula--> che insorge nell'[[Ippocampo (anatomia)|ippocampo]], nel [[giro paraippocampale]] e nell'[[amigdala]] che sono localizzati nella faccia interna del lobo temporale.
* '''Epilessia del lobo temprale laterale''' (LTLE, "lateral temporal lobe epilepsy") che insorge nella [[neocorteccia]] sulla superficie più esterna del lobo temporale del cervello, al di sotto della calotta cranica delimitata approssimativamente dall'[[osso temporale]].
A causa delle forti interconnessioni, le crisi che cominciano nelle aree temporali sia mediali che laterali spesso si diffondono per coinvolgere entrambe le aree e si propagano ad aree vicine dello stesso lato del cervello, e possono proiettarsi (tramite il [[corpo calloso]]) sul lobo temporale contro-laterale. Le epilessie del lobo temporale possono diffondersi ai lobi parietali e occipitali che sono connessi direttamente con esso e da questi propagarsi al lobo frontale. Le cause o [[eziologia]] delle diverse epilessie del lobo temporale variano e vengono discusse più sotto.
==Sindrome epilettica del lobo temporale (TLE)==
La [[sindrome]] classica della TLE può cominciare quando si verifica una lesione dell'area cerebrale dell'[[ippocampo]] che causa morte neuronale. Alcune [[malattie infettive]] dell'infanzia possono causare febbre alta. L'immaturità del sistema della [[termoregolazione]] dei bambini, e la febbre possono causare drastici incrementi della temperatura corporea. <ref> [http://www.ipasvicomo.it/documenti/art_12_49.pdf Termoregolazione nel neonato critico] {{pdf}} </ref> In alcuni bambini la temperatura corporea elevata può causare [[convulsioni febbrili]].
Le convulsioni febbrili sono relativamente normali dal momento che avvengono nel 2-5% dei bambini al di sotto dei 5 anni. <ref> {{en}}
[https://www.clinicalkey.com/topics/pediatrics/febrile-seizures.html Epidemiology - Prevalence: 2% to 4% in children under 5 years old in the U.S.] </ref> Tipicamente durano pochi minuti o anche pochi secondi, ma non sono convulsioni motorie gravi e non sono seguiti dal [[Semeiotica|segno]] della debolezza in un lato del corpo (constatata per la minore resistenza allo spostamento passivo). In un piccolo numero di bebè, queste convulsioni possono durare per più di un ora e comportano ripetuti eventi convulsivi. Queste sono note come crisi epilettiche complesse e possono essere associate ad una precedente TLE (l'[[iperpiressia]] scatena i sintomi).{{Citation needed|date=April 2010}} Rimane controverso se le crisi convulsive complesse causate dalla febbre possano essere la causa prima delle TLE,{{Citation needed|date=April 2010}} oppure se sono semplicemente la prima manifestazione della condizione nota come TLE.
==Cause==
Un nesso tre le [[convulsioni febbrili]] (attacchi epilettici che coincidono con episodi febbrili nei bambini più piccoli) e la successiva epilessia del lobo temporale viene suggerito dalla casistica, ma il ruolo esatto resta poco chiaro.<ref name="FEBSTAT">{{cite journal |author=Shinnar S, Hesdorffer DC, Nordli DR, ''et al.'' |title=Phenomenology of prolonged febrile seizures: results of the FEBSTAT study |journal=Neurology |volume=71 |issue=3 |pages=170–6 |year=2008 |month=July |pmid=18525033 |doi=10.1212/01.wnl.0000310774.01185.97 |url=http://www.neurology.org/cgi/pmidlookup?view=long&pmid=18525033}}</ref><ref name="pmid12552033">{{cite journal |author=Tarkka R, Pääkkö E, Pyhtinen J, Uhari M, Rantala H |title=Febrile seizures and mesial temporal sclerosis: No association in a long-term follow-up study |journal=Neurology |volume=60 |issue=2 |pages=215–8 |year=2003 |month=January |pmid=12552033 |doi= 10.1212/01.WNL.0000037482.55894.B1 }}</ref><ref name="pmid17897728">{{cite journal |author=Dubé CM, Brewster AL, Richichi C, Zha Q, Baram TZ |title=Fever, febrile seizures and epilepsy |journal=Trends Neurosci. |volume=30 |issue=10 |pages=490–6 |year=2007 |month=October |pmid=17897728 |doi=10.1016/j.tins.2007.07.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0166-2236(07)00209-3 |pmc=2766556}}</ref><ref name="pmid10563622">{{cite journal |author=Berg AT, Shinnar S, Levy SR, Testa FM |title=Childhood-onset epilepsy with and without preceding febrile seizures |journal=Neurology |volume=53 |issue=8 |pages=1742–8 |year=1999 |month=November |pmid=10563622 |doi=10.1212/WNL.53.8.1742 }}</ref><ref name="pmid11402099">{{cite journal |author=Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B |title=Early development of intractable epilepsy in children: a prospective study |journal=Neurology |volume=56 |issue=11 |pages=1445–52 |year=2001 |month=June |pmid=11402099 |doi=10.1212/WNL.56.11.1445 }}</ref>
Alcuni studi sull'[[Ippocampo (anatomia)|ippocampo]] eseguiti con la [[risonanza magnetica]] in pazienti in [[stato epilettico]], tendono a dimostrare l'ipotesi che lunghi periodi di epilessia danneggiano il cervello. <ref name="pmid18356445">{{cite journal |author=Provenzale JM, Barboriak DP, VanLandingham K, MacFall J, Delong D, Lewis DV |title=Hippocampal MRI signal hyperintensity after febrile status epilepticus is predictive of subsequent mesial temporal sclerosis |journal=AJR Am J Roentgenol |volume=190 |issue=4 |pages=976–83 |year=2008 |month=April |pmid=18356445 |doi=10.2214/AJR.07.2407 |url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=18356445}}</ref><ref name="pmid11110527">{{cite journal |author=Bronen RA |title=The status of status: seizures are bad for your brain's health |journal=AJNR Am J Neuroradiol |volume=21 |issue=10 |pages=1782–3 |year=2000 |pmid=11110527 |doi= |url=http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=11110527}}</ref><ref name="pmid17690084">{{cite journal |author=Sankar R, Rho JM |title=Do seizures affect the developing brain? Lessons from the laboratory |journal=J. Child Neurol. |volume=22 |issue=5 Suppl |pages=21S–9S |year=2007 |month=May |pmid=17690084 |doi=10.1177/0883073807303072 |url=http://jcn.sagepub.com/cgi/pmidlookup?view=long&pmid=17690084}}</ref> Alcuni casi di MTLE si presentano senza i tipici cambiamenti della [[sclerosi mesiale temporale]] o non dimostrano altre anomale alla scansione MRI, questa condizione è stata denominata epilessia paradossa del lobo temporale mesiale. L'epilessia in questi pazienti tende a vedersi in età maggiori, fatto che potrebbe suggerire che un evento in giovane età conduce al danno ippocampale che causa la MTLE.<ref name="pmid15926717">{{cite journal |author=Cohen-Gadol AA, Bradley CC, Williamson A, ''et al.'' |title=Normal magnetic resonance imaging and medial temporal lobe epilepsy: the clinical syndrome of paradoxical temporal lobe epilepsy |journal=J. Neurosurg. |volume=102 |issue=5 |pages=902–9 |year=2005 |month=May |pmid=15926717 |doi= 10.3171/jns.2005.102.5.0902|url=}}</ref><ref name="pmid8750318">{{cite journal |author=Luby M, Spencer DD, Kim JH, deLanerolle N, McCarthy G |title=Hippocampal MRI volumetrics and temporal lobe substrates in medial temporal lobe epilepsy |journal=Magn Reson Imaging |volume=13 |issue=8 |pages=1065–71 |year=1995 |pmid=8750318 |doi= 10.1016/0730-725X(95)02014-K|url=http://linkinghub.elsevier.com/retrieve/pii/0730-725X(95)02014-K}}</ref>
Anche se questa teoria necessita di conferma, alcuni studi hanno indicato che l'[[herpesvirus umano 6]] (HHV-6) è un possibile anello di congiunzione tra le convulsioni febbrili e lo sviluppo della MTLE. Alcuni studi suggeriscono che l'infezione con HHV-6 avvenga prima delle convulsioni febbrili. <ref name="pmid8035839">{{cite journal |author=Hall CB, Long CE, Schnabel KC, ''et al.'' |title=Human herpesvirus-6 infection in children. A prospective study of complications and reactivation |journal=N. Engl. J. Med. |volume=331 |issue=7 |pages=432–8 |year=1994 |month=August |pmid=8035839 |doi= 10.1056/NEJM199408183310703|url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8035839&promo=ONFLNS19}}</ref><ref name="pmid7608818">{{cite journal |author=Barone SR, Kaplan MH, Krilov LR |title=Human herpesvirus-6 infection in children with first febrile seizures |journal=J. Pediatr. |volume=127 |issue=1 |pages=95–7 |year=1995 |month=July |pmid=7608818 |doi= 10.1016/S0022-3476(95)70263-6|url=http://linkinghub.elsevier.com/retrieve/pii/S0022-3476(95)70263-6}}</ref><ref name="pmid8387564">{{cite journal |author=Kondo K, Nagafuji H, Hata A, Tomomori C, Yamanishi K |title=Association of human herpesvirus 6 infection of the central nervous system with recurrence of febrile convulsions |journal=J. Infect. Dis. |volume=167 |issue=5 |pages=1197–200 |year=1993 |month=May |pmid=8387564 |doi= 10.1093/infdis/167.5.1197|url=}}</ref><ref name="pmid10630916">{{cite journal |author=Suga S, Suzuki K, Ihira M, ''et al.'' |title=Clinical characteristics of febrile convulsions during primary HHV-6 infection |journal=Arch. Dis. Child. |volume=82 |issue=1 |pages=62–6 |year=2000 |month=January |pmid=10630916 |pmc=1718177 |doi= 10.1136/adc.82.1.62|url=http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=10630916}}</ref> Comunque, soltanto una minoranza delle infezioni HHV-6 primarie può essere sicuramente associata con le convulsioni febbrili.<ref name="pmid15728809">{{cite journal |author=Zerr DM, Meier AS, Selke SS, ''et al.'' |title=A population-based study of primary human herpesvirus 6 infection |journal=N. Engl. J. Med. |volume=352 |issue=8 |pages=768–76 |year=2005 |month=February |pmid=15728809 |doi=10.1056/NEJMoa042207 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=15728809&promo=ONFLNS19}}</ref> Ma, altri studi [[Microbiologia|microbiologico]]-[[Istologia|istologici]] hanno scoperto il [[DNA]] del HHV-6 in tessuti cerebrali rimossi durante la chirurgia del MTLE.<ref name="pmid16209861">{{cite journal |author=Yamashita N, Morishima T |title=HHV-6 and seizures |journal=Herpes |volume=12 |issue=2 |pages=46–9 |year=2005 |month=October |pmid=16209861 |doi= |url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0969-7667&volume=12&issue=2&spage=46&aulast=Yamashita}}</ref><ref name="pmid17804017">{{cite journal |author=Karatas H, Gurer G, Pinar A, ''et al.'' |title=Investigation of HSV-1, HSV-2, CMV, HHV-6 and HHV-8 DNA by real-time PCR in surgical resection materials of epilepsy patients with mesial temporal lobe sclerosis |journal=J. Neurol. Sci. |volume=264 |issue=1–2 |pages=151–6 |year=2008 |month=January |pmid=17804017 |doi=10.1016/j.jns.2007.08.010 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-510X(07)00570-9}}</ref><ref name="pmid17535102">{{cite journal |author=Fotheringham J, Donati D, Akhyani N, ''et al.'' |title=Association of Human Herpesvirus-6B with Mesial Temporal Lobe Epilepsy |journal=PLoS Med. |volume=4 |issue=5 |pages=e180 |year=2007 |month=May |pmid=17535102 |pmc=1880851 |doi=10.1371/journal.pmed.0040180 |url=http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040180}}</ref><ref name="pmid14638964">{{cite journal |author=Donati D, Akhyani N, Fogdell-Hahn A, ''et al.'' |title=Detection of human herpesvirus-6 in mesial temporal lobe epilepsy surgical brain resections |journal=Neurology |volume=61 |issue=10 |pages=1405–11 |year=2003 |month=November |pmid=14638964 |doi=10.1212/01.WNL.0000094357.10782.F9 }}</ref>
Raramente, la MTLE può essere ereditaria o secondaria a qualche tipo di [[tumore del cervello]], a meningite spinale, a encefalite, a lesioni alla testa o a malformazioni artero-venose. La MTLE può verificasi in associazione con altre malformazioni del cervello. Più spesso, la causa non può essere determinata con certezza (si definisce [[epilessia criptogenetica]]).
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LTLE is less common. It can be hereditary, as in [[Autosomal dominant|Autosomal Dominant]] Lateral Temporal Lobe Epilepsy (ADLTLE) with auditory or visual features, but can also be associated with tumors, meningitis, encephalitis, trauma, vascular malformations or congenital brain malformations. Again, in many affected persons it is common that no cause can be identified.
Dispersion of granule cell layer in the hippocampal [[dentate gyrus]] is occasionally seen in temporal lobe epilepsy and has been linked to the downregulation of [[reelin]],
-->
<!--
--><ref name="TLE1">{{cite journal |author=Haas CA, Dudeck O, Kirsch M, ''et al.'' |title=Role for reelin in the development of granule cell dispersion in temporal lobe epilepsy |journal=J. Neurosci. |volume=22 |issue=14 |pages=5797–802 |year=2002 |month=July |pmid=12122039 }}</ref><ref name="TLE2">{{cite journal |author=Heinrich C, Nitta N, Flubacher A, ''et al.'' |title=Reelin deficiency and displacement of mature neurons, but not neurogenesis, underlie the formation of granule cell dispersion in the epileptic hippocampus |journal=J. Neurosci. |volume=26 |issue=17 |pages=4701–13 |year=2006 |month=April |pmid=16641251 |doi=10.1523/JNEUROSCI.5516-05.2006 }}</ref><!--
a protein that normally keeps the layer compact by containing the [[neuronal migration]]. It is unknown whether changes in reelin expression play a role in epilepsy. -->
==Sintomi==
I sintomi riferiti dal paziente e i segni osservabili da altri, durante le crisi che iniziano nel lobo temporale dipendono dalle particolari regioni del lobo temporale interessate dalle onde epilettiche e dal tipo e frequenza di queste. La "International Classification of Epileptic Seizures" pubblicata nel [[1981]] dalla "International League Against Epilepsy" (ILAE) riconosce tre tipi di crisi epilettiche nelle persone con TLE.<ref>Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. ''Epilepsia'' 1981;22:489-501.</ref>
# [[Crisi parziale semplice|Crisi parziali semplici]] (SPS) che coinvolgono piccole aree del lono temporale come l'amigdala oppure l'ippocampo. Il termine "semplice" vuole indicare che non vi sono alterazioni dello [[stato di coscienza]]. Nell'epilessia del lobo temporale del tipo SPS si hanno soltanto "sensazioni" più o meno strane, che possono essere di tipo [[Mnestesi|mnestico]] come il [[déjà vu]] (una sensazione di aver già visto un luogo che risulta familiare oppure di aver già vissuto un esperienza), [[jamais vu]] (l'opposta sensazione di non aver mai visto un luogo invece familiare), uno specifico ricordo o insieme di ricordi, o l'[[amnesia]]. Queste sensazioni possono essere uditive come un suono oppure una musica, gustative come un sapore, oppure olfattive come un odore che invece non è fisicamente presente. Le sensazioni possono anche essere visive, oppure includere vaghi stati di nausea o di movimenti degli organi interni.
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Possono sentirsi sensazioni tattili latter feelings may seem to move over the body. Dysphoric or euphoric feelings, fear, anger, and other sensations can also occur during SPS. Often, it is hard for persons with SPS of TLE to describe the feeling. SPS are often called "auras" by lay persons who mistake them for a warning sign of a subsequent seizure. In fact, they are actual seizures in and of themselves. Persons experiencing only SPS may not recognize what they are or seek medical advice about them. SPS may or may not progress to the seizure types listed below.
-->
<!--
# [[Complex partial seizure|Complex Partial Seizures]] (CPS) by definition are seizures which impair consciousness to some extent. This is to say that they alter the person's ability to interact with his or her environment. They usually begin with an SPS, but then the seizure spreads to a larger portion of the temporal lobe resulting in impaired consciousness. Signs may include motionless staring, automatic movements of the hands or mouth, altered ability to respond to others, unusual speech, or unusual behaviors.
# Seizures which begin in the temporal lobe but then spread to the whole brain are known as [[Secondarily Generalized Tonic-Clonic Seizures]] (SGTCS). These begin with an SPS or CPS phase initially, but then the arms, trunk and legs stiffen (tonic) in either a flexed or extended position and then clonic jerking of the limbs often occurs. GTCS are often known in the vernacular as convulsions or "grand mal" (originally a French term) seizures.
Following each of these seizures, there is some period of recovery in which neurological function is altered. This is called the [[postictal state]]. The degree and length of the impairment directly correlates with the severity of the 3 seizure types listed above. SPS often last less than 60 seconds, CPS often last less than 2 minutes, and SGTCS usually last less than 3 minutes. The postictal state in the case of CPS and GTCS often lasts much longer than the seizure [[ictus]] itself. Because a major function of the temporal lobe is short-term memory, CPS and GTCS cause amnesia for the seizure. As a result, many persons with temporal lobe CPS and GTCS will not remember having had a seizure.
Local and national laws exist regarding the operation of vehicles, aircraft and vessels by patients with epilepsy. Most licensing departments do not allow driving of vehicles by persons with CPS or GTCS until they have been seizure-free for a specified period of time. The laws are complex and varied; affected persons must check with the appropriate licensing authority. In a few locations, health care providers are legally-required to report patients with epilepsy (and other medical conditions which cause episodes of altered consciousness) to their local department of motor vehicles.<ref>Sample New Jersey, USA, medical report form: http://www.state.nj.us/mvc/pdf/Violations/MVC-Form_MR-4.pdf</ref>
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==Terapie==
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There are many oral [[medication]]s available for the management of epileptic seizures. They were previously called [[anticonvulsants]] however this term is misleading because most seizures are not convulsions. The modern term is [[antiepileptic drugs]] (AEDs). In TLE, the most commonly used older AEDs are [[phenytoin]], [[carbamazepine]], [[primidone]], [[valproate]] and [[phenobarbital]]. Newer drugs, such as [[gabapentin]], [[topiramate]], [[levetiracetam]], [[lamotrigine]], [[pregabalin]], [[tiagabine]], [[lacosamide]], and [[zonisamide]] promise similar effectiveness, possibly with fewer [[adverse effect|side-effects]]. [[Felbamate]] and [[vigabatrin]] are newer AEDs, but can have serious [[adverse effects]] so they are not considered first-line AEDs. Nearly all AEDs function by decreasing the excitation of [[neurons]] (e.g., by blocking fast or slow [[sodium channels]] or modulating [[calcium channels]]) or by enhancing the inhibition of neurons (e.g., by potentiating the effects of inhibitory [[neurotransmitters]] like [[GABA]]). Unfortunately, many patients with medial temporal lobe epilepsy (up to one-third) will not experience adequate seizure control with medication.<ref>{{cite journal |author=Kwan P, Brodie MJ |title=Early identification of refractory epilepsy |journal=N. Engl. J. Med. |volume=342 |issue=5 |pages=314–9 |year=2000 |month=February |pmid=10660394 |doi=10.1056/NEJM200002033420503}}</ref>
For patients with medial TLE whose seizures remain uncontrolled after trials of several AEDs (intractable), resective [[surgery]] should be considered.<ref>{{cite journal |author=Engel J |title=Surgery for seizures |journal=N. Engl. J. Med. |volume=334 |issue=10 |pages=647–52 |year=1996 |month=March |pmid=8592530 |doi=10.1056/NEJM199603073341008 |url=http://www.nejm.org/doi/abs/10.1056/NEJM199603073341008?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed}}</ref> Epilepsy surgery has been performed since the 1860s and physicians and surgeons had observed for decades that it was highly effective in producing seizure freedom. However, it was not until 2001 that a scientifically sound study was performed on the effectiveness of temporal lobectomy.<ref name="pmid11484687">{{cite journal | last1 = Wiebe | first1= S | last2 = Blume | first2 = Warren T. | last3 = Girvin | first3 = John P. | last4 = Eliasziw | first4 = Michael | author5 = Effectiveness Efficiency of Surgery for Temporal Lobe Epilepsy Study Group | year = 2001 | title = A randomized, controlled trial of surgery for temporal lobe epilepsy | journal = N Engl J Med | volume = 345 | issue = 5| pages = 311–8 | doi = 10.1056/NEJM200108023450501 | pmid = 11484687 }}</ref> This study proved that after the failure of several AEDs to control seizures in TLE temporal lobe surgery is far more effective in producing seizure freedom than is additional medication trials. The unanswered question that remains is how many medications a person must fail before considering surgery. A United States sponsored research study called ERSET was begun to answer the question of whether surgery can successfully be performed early in the course of TLE. The primary outcome variable was freedom from disabling seizures during year 2 of follow-up. The study ended earlier than anticipated with a total enrollment of 38 patients. Of these, 23 were enrolled in the anti-epileptic drug (AED) treatment arm, whereas 15 received both AED treatment and surgery for TLE. The results showed that none of the patients who only received AED achieved the study endpoint; that is, none were free of disabling seizures during year 2 of follow-up. In contrast, 11 of the 15 who both received AED and surgery for TLE were free of disabling seizures (odds ratio = ∞; 95% CI, 11.8 to ∞; P < .001).<ref name="pmid22396514">{{cite journal | doi = 10.1001/jama.2012.220 | last1 = Engle | first1 = J | last2 = McDermott | first2 = MP | last3 = Wiebe | first3 = S | last4 = Langfitt | first4 = JT | last5 = Stern | first5 = JM | last6 = Dewar | first6 = S | last7 = Sperling | first7 = MR | last8 = Gardiner | first8 = I | last9 = Erba | first9 = G | year = 2012 | title = Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial | journal = J Am Med Assoc |volume = 307 | issue = 9 | pages = 322–30 | pmid = 22396514}}</ref>
In preparation for these surgeries, patients are monitored by various methods to determine the focus of their seizures (that is, the region of the brain where seizures tend to arise before spreading). This can be done with [[video-EEG monitoring]], intracranial [[EEG]] (where electrodes are placed beneath the skull, either within or resting just outside the brain), or [[SPECT]] imaging. [[MRI]] studies may additionally be used to seek evidence of hippocampal sclerosis. Once the epileptic focus has been determined, it can be excised, which usually involves removing part of the [[hippocampus]] and often the [[amygdala]]. To avoid removing areas of the brain responsible for speech (so-called "eloquent" areas), the surgical team will conduct a [[Wada test]] pre-operatively, wherein [[amobarbital]] is injected in the left or right [[carotid artery]] to temporarily quiet one half of the brain. If the patient performs poorly on neuropsychological testing during the intracarotid amobarbital (Wada) test, the surgical team may advise the patient against surgery or may offer a more limited operation.
If a person is not an optimal candidate for epilepsy surgery, then AEDs not previously tried, the [[vagus nerve stimulator]], or AEDs in clinical research trials might be alternative treatments. {{Citation needed|date=April 2010}}For children, the [[ketogenic diet]] may also be tried. {{Citation needed|date=April 2010}}Other possible future therapies such as brain cortex responsive neural stimulators, [[deep brain stimulation]], and stereotactic radiosurgery (such as [[gamma knife]]) are undergoing research studies for treatment of TLE and other forms of epilepsy.{{Citation needed|date=April 2010}}
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==Social and artistic influence==
===Epilessia del lobo temporale e influenza sull'arte===
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As Eve LaPlante discusses in her book, ''Seized'', the intense emotions, sensory experience including vibrancy of colors, and particular mental state provoked by temporal lobe abnormalities may have contributed to the creation of significant works of art. A number of well-known writers and artists are known, or in many cases suspected to have had temporal lobe epilepsy, aggravated, in some cases, by [[alcoholism]]. They include [[Vincent Van Gogh]], Charles Dodgson (a.k.a. [[Lewis Carroll]]), [[Edgar Allan Poe]], [[Fyodor Dostoevsky]] (whose novel ''[[The Idiot (novel)|The Idiot]]'' features a protagonist with epilepsy, Prince Myshkin), [[Gustave Flaubert]], [[Philip K. Dick]], [[Sylvia Plath]] and contemporary [[author]] [[Thom Jones]]. Peter O'Leary has also discussed this in relation to work of poet Philip Jenks in his "Gnostic Contagion: Robert Duncan and the Poetry of Illness". [[Sadi Ranson|Sadi Ranson-Polizzotti]] has discussed the significance of Lewis Carroll's epilepsy [http://tantmieux.squarespace.com/lewis-carroll/ online] and in a forthcoming book on the subject.
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===Temporal Lobe Epilepsy, Neurotheology and Paranormal Experience===
The first researcher to note and catalog the abnormal experiences associated with TLE was neurologist [[Norman Geschwind]], who noted a constellation of symptoms, including [[hypergraphia]], [[hyperreligiosity]], [[Syncope (medicine)|fainting spells]], and [[pedantic|pedantism]], often collectively ascribed to a condition known as [[Geschwind syndrome]].
[[Vilayanur S. Ramachandran]] explored the neural basis of the hyperreligiosity seen in TLE using [[galvanic skin response]] (which correlates with emotional arousal) to determine whether the hyperreligiosity seen in TLE was due to an overall heightened emotional state or was specific to religious stimuli (Ramachandran and Blakeslee, 1998). By presenting subjects with neutral, sexually arousing and religious words while measuring GSR, Ramachandran was able to show that patients with TLE showed enhanced emotional responses to the religious words, diminished responses to the sexually charged words, and normal responses to the neutral words. These results suggest that the medial temporal lobe is specifically involved in generating some of the emotional reactions associated with religious words, images and symbols.
[[Cognitive neuroscience]] researcher [[Michael Persinger]] asserts that stimulating the temporal lobe [[electromagnetism|electromagnetically]] can cause TLE and trigger [[hallucination]]s of apparent [[paranormal phenomena]] such as [[ghost]]s and [[UFO]]s. Persinger has even created a "[[God helmet]]" which purportedly can evoke [[altered states of consciousness]] through stimulation of the [[parietal lobe|parietal]] and temporal lobes. [[Neurotheology|Neurotheologians]] speculate that individuals with temporal lobe epilepsy, having a natural tendency to experience states of consciousness such as [[Euphoria (emotion)|euphoria]] or ''[[samādhi]]'', have functioned in human history as religious figures or [[shaman]]s.
A 2012 paper in the [[Journal of Neuropsychiatry and Clinical Neurosciences]] suggested that temporal lobe epilepsy was a less likely explanation for the revelational experiences of prominent religious figures such as [[Abraham]], [[Moses]], [[Jesus]] and [[Saint Paul]] due to the complexity of their interactions with their visions, a lack of reported stereotypy, absence of amnestic periods, absence of reported automatisms or generalized motor events with their revelatory experiences. Psychiatric conditions associated with [[psychotic]] spectrum symptoms were reasoned to be more plausible explanations their revelatory experiences.<ref>Murray, ED.; Cunningham MG, Price BH. (1). "The role of psychotic disorders in religious history considered". J Neuropsychiatry Clin Neuroscience 24 (4): 410–26. doi:10.1176/appi.neuropsych.11090214. PMID 23224447</ref>
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==Epilessia del lobo temporale e ormoni==
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Sex hormones can influence the timing and frequency of seizure activity. [[Estrogen]] is pro-epileptic and [[progesterone]] is anti-epileptic. These counterbalancing effects may account for "[[catamenial epilepsy]]" i.e. epilepsy preceding or made more severe prior to [[menstruation]] or during [[peri-ovulation]]. Gender may differentially influence neocortical pathologies in patients with refractory temporal lobe epilepsy.<ref>{{cite journal |author=Doherty MJ, Rostad SW, Kraemer DL, Vossler DG, Haltiner AM |title=Neocortical gliosis in temporal lobe epilepsy: gender-based differences |journal=Epilepsia |volume=48 |issue=8 |pages=1455–9 |year=2007 |month=August |pmid=17430405 |doi=10.1111/j.1528-1167.2007.01046.x}}</ref>
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==Epilessia del lobo temporale: personalità e depressione==
===Personalità===
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The effect of temporal lobe epilepsy on personality is a historical observation dating back to the 1800s. Historical psychologists such as Sigmund Freud stated, “We know that epilepsy produces these remarkable changes in the personality."[http://web.ebscohost.com/ehost/detail?vid=9&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2009-12026-006] Personality change in temporal lobe epilepsy is seen as a chronic syndrome. It is classified as a chronic syndrome when symptoms from a particular disorder persist for a minimum of 3 months. Personality and behavioral changes can be a result of the seizures from temporal lobe epilepsy. Norman Geschwind [http://web.ebscohost.com/ehost/detail?vid=9&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2009-12026-006] suggested that a reason for this personality change could be the ___location in the brain where the syndrome takes place. Geschwind article stated, “It’s the ___location of the lesions producing temporal lobe epilepsy. These lesions are characteristically on the surface of the temporal lobe.[http://web.ebscohost.com/ehost/detail?vid=9&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2009-12026-006]” Furthermore, “These lesions lie directly in structures with pathways into the parts of the brain that are involved in emotional behavior."[http://web.ebscohost.com/ehost/detail?vid=9&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2009-12026-006]”Emotional behavior in this regards can be seen as actions that contributes to an individual’s personality who has temporal lobe epilepsy.
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===Depressione===
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Individuals suffering from temporal lobe epilepsy have a high prevalence of depression [http://web.ebscohost.com/ehost/detail?vid=15&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2011-29111-001]. Depressive symptoms have been estimated up to 20-55%[http://www.psychinfo.com] in individuals that have temporal lobe epilepsy. Depressive symptoms undoubtedly take a toll on individual’s lives that are not diagnosed with temporal lobe epilepsy. Individuals who have temporal epilepsy and depression are suggested to experience from a quality of life decrease [http://web.ebscohost.com/ehost/detail?vid=13&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2011-25352-010]. This decrease in quality of life has lead researchers to findings of suicidal thoughts in these individuals [http://web.ebscohost.com/ehost/detail?vid=11&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2011-28383-018]. Research on this topic has been conducted for decades. One study suggests the connection between temporal lobe epilepsy and depression is the pathogenic mechanism underlying in depression [http://web.ebscohost.com/ehost/detail?vid=17&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2012-04815-031]. That epilepsy and psychiatric disorders could possibly share common pathogenic pathways [http://web.ebscohost.com/ehost/detail?vid=17&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2012-04815-031]. These pathways may influence the correlation among the two. Whether or not the depressive symptoms start prior or after the epileptic attacks are still unclear [http://web.ebscohost.com/ehost/detail?vid=7&hid=111&sid=c8086c06-34b1-49d7-8ec0-76937b381df3%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2010-16843-005], but the presence of a correlation is very evident.
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==Voci correlate==
* [[Amigdala]]
* [[Aura (medicina)|Aura epilettica]]
* [[Demenza bipolare]]
* [[Déjà vu]]
* [[Epilessia]]
* [[Euforia]]
* [[Sindrome di Geschwind]]
* [[Elmetto di Dio]]
* [[Sclerosi dell'ippocampo]]
* [[Medianità]]
* [[Neurotheology]]
* [[Epilessia post-traumatica]]
* [[Prosopagnosia]] (cecità ai volti)
* [[Estasi religiosa]]
* [[Lobo temporale]]
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==Media Depictions==
* Film ''[[The Exorcism of Emily Rose]]'', 2005.
* Film ''[[Deceiver (film)|Deceiver]]'', 1997.
* Film ''[[Happy Accidents]]'', 2001.
* ''[[Law and Order: Criminal Intent]]'' episode "The Gift," 2003.
* Television show "[[Veronica Mars]]," 2004-2007, main character Veronica Mars suspected her ex-boyfriend [[Duncan Kane]] of murdering his sister and her best friend, [[Lilly Kane]], after discovering he had been treated for TLE symptoms. (Wrongly described on the show as "Type Four Epilepsy.")
* Television show "[[Medium (TV series)|Medium]]," 2005-2011, starring [[Patricia Arquette]]
* Television show "[[Firefly (TV series)|Firefly]]," 2002, film ''Serenity'', 2005, both created by [[Joss Whedon]], feature character [[River Tam]], affected with symptoms of TLE after alteration of amygdala, brain component related to TLE
* A current story line on the CBS daytime drama, ''[[The Young and the Restless]]'', features character [[Victor Newman]] being diagnosed with TLE.
* Television Show "[[ER (TV series)|ER]]" 2007, episode "Crisis of Consciousness", patient predicts engine will fall on his head if he is not moved.
* Television Show "[[Day Break]]" on ABC, Jared is said to have TLE.{{Citation needed|date=July 2010}}
* Television show "[[Eli Stone]]," 2008, title character (Johnny Lee Miller) loosens life and changes priorities after neurological condition prompts auditory/extrasensory hallucinations, premonitions and dawning spiritual enlightenment.
* Book, ''[[The Terminal Man]]'' by [[Michael Crichton]]
* Book, "The Spiral Staircase" by [[Karen Armstrong]], an autobiography including descriptions of her long undiagnosed Temporal lobe epilepsy.
* The music video for "Epilepsy is Dancing" from the album [[The Crying Light]] by [[Antony and the Johnsons]]
*Television Show "[[Perception (U.S. TV series)|Perception]]", season 1, episode 5 "Messenger" starring [[Eric McCormack]]
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==Bibliografia==
* {{en}} {{cite book |author=LaPlante, Eve |title=Seized: Temporal Lobe Epilepsy as Medical, Historical and Artistic Phenomenon |year=1993 |isbn=978-0-06-016673-1 }} Discusses link between TLE and artistic creativity.
* {{en}} {{cite news |title=Transcript of (BBC TV series) "Horizon" documentary "God on the Brain" |publisher=BBC.co.uk |url=http://www.bbc.co.uk/science/horizon/2003/godonbraintrans.shtml}}
* {{en}} {{cite web |title=Theological Aspects of Temporal Lobe Function |author=Paraclete |url=http://www.everything2.com/index.pl?node_id=1747573}}, including bibliography
* {{en}} {{cite journal |author=Bard P |year=1934 |url=http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6X04-4NVH9JC-1&_user=10&_coverDate=07/31/1934&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1417342623&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3cf4f027b755d2c7d792414461ff7ada |title=On emotional expression after decortication with some remarks on certain theoretical views |journal=[[Psychological Review]] |volume=41 |pages=309–329 |doi=10.1037/h0070765 |issue=4 }}
* {{en}} {{cite journal | doi = 10.1176/appi.ajp.159.4.519 | author = Blumer D | year = 2002 | title = The illness of Vincent van Gogh | journal = Am J. Psychiatry | volume = 159 | issue = 4| pages = 519–526 | pmid = 11925286 }}
* {{fr}} {{cite journal | author = Broca P | year = 1878 | title = Anatomie comparé de circonvolutions cérébrales. Le grand lobe limbique et la scissure limbige dans la série des mammiféres | journal = Revue d'Anthropologie | volume = 1 | pages = 385–498 }}
* {{en}} {{cite journal | doi = 10.2307/1415404 | author = Cannon WB | year = 1927 | title = The James-Lange theory of emotion| journal = Am J. Psychology | volume = 39 | issue = 1/4| pages = 106–124 | jstor = 1415404 }}
* {{en}} {{cite journal | doi = 10.1192/bjp.117.540.497 | author = Dewhurt K, Beard AW | year = 1970 | title = Sudden religious conversions in temporal lobe epilepsy | journal = Br. J. Psychiatry | volume = 117 | issue = 540| pages = 497–507 | pmid = 5480697 }}
* {{en}} {{cite journal | doi = 10.1111/j.1469-8986.1966.tb02690.x | author = Hohmann GW | year = 1966 | title = Some effects of spinal cord lesions on experienced emotional feelings | journal = Psychophysiology | volume = 3 | issue = 2| pages = 143–56 | pmid = 5927829 }}
* {{en}} {{cite journal | author = James W | year = 1884 | title = What is an emotion? | journal = Mind | volume = 9 | pages = 188–205 | doi=10.1093/mind/os-IX.34.188 | issue = 34}}
* {{en}} {{cite book |author=Kingsley, RE |title=Concise Text of Neuroscience |publisher=Lippincott Williams and Wilkins |___location= |year=2000 |pages=884–8 |edition=2nd }}
* Lange CG, 1887, "Uber Gemuthsbewegungen", Liepzig: T Thomas
* {{en}} {{cite journal | author = Lowe J, Carroll D | year = 1985 | title = The effects of spinal injury on the intensity of emotional experience | journal = Br J Clin Psychol | volume = 24 | issue = 2| pages = 135–6 | doi = 10.1111/j.2044-8260.1985.tb01327.x }}
* {{en}} {{cite journal | author = MacLean PD | year = 1955 | title = The limbic system ("visceral brain") and emotional behaviour | journal = Arch. Neurology and Psychiatry | volume = 73 | issue = 2 | pages = 130–4 | doi = 10.1001/archneurpsyc.1955.02330080008004 }}
* {{en}} Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012. ISBN 1437704344 | ISBN 978-1437704341
* {{en}} {{cite journal | doi = 10.1046/j.1440-1819.1998.00397.x | author = Ogata A, Miyakawa T | year = 1998 | title = Religious experiences in epileptic patients with a focus on ictus-related episodes | journal = Psychiatry and Clinical Neuroscience | volume = 52 | pages = 321–5 | issue = 3 }}
* {{en}} {{cite journal | author = Papez JW | year = 1937 | title = A proposed mechanism of emotion | journal = Arch. Neurology and Psychiatry | volume = 38 | issue = 4 | pages = 725–743 | doi = 10.1001/archneurpsyc.1937.02260220069003 }}
* {{en}} {{cite journal | author = Persinger MA | year = 1983 | title = Religious and mystical experiences as artefacts of temporal lobe function: a general hypothesis | journal = Percept Mot Skills | volume = 57 | issue = 3| pages = 1255–62 | pmid = 6664802 | doi = 10.2466/pms.1983.57.3f.1255 }}
* {{en}} {{cite book |author=Ramachandran VS, Blakeslee |chapter=Chapter 9 |title=Phantoms in the Brain |publisher=Fourth Estate |year=1998 }}
* {{en}} {{cite book |author=Thompson JG |title=The Psychobiology of Emotion |publisher=Plenum Press |___location=New York |year=1988 |edition=1st }}
* {{en}} {{cite web |title=Lewis Carroll |author=Sadi Ranson-Polizzotti |url=http://tantmieux.squarespace.com/lewis-carroll/ |publisher=tantmieux.squarespace.com}}
:::::'''''Ottobre 2016'''''
==Note==
* 23-10: Maratona di Valencia - {{Bandiera|ESP}} [[Valencia]]
{{Reflist|2}}
* 23-10: [[Maratona di Venezia]] - {{Bandiera|ITA}} [[Venezia]]
* 30-10: [[Maratona di Francoforte]] - {{Bandiera|DEU}} [[Francoforte sul Meno]]
* 30-10: Maratona di Shanghai - {{Bandiera|CHN}} [[Shanghai]]
* 30-10: Marseille-Cassis 20 km - {{Bandiera|FRA}} [[Marsiglia]]-[[Cassis]]
:::::'''''Novembre 2016'''''
{{Epilessia}}
* 6-11: [[Maratona di New York]] - {{Bandiera|USA}} [[New York]]
* 13-11: Cross de Atapuerca - {{Bandiera|ESP}} [[Burgos (Spagna)|Burgos]]
* 13-11: Maratona delle Alpi Marittime Nizza-Cannes - {{Bandiera|FRA}} [[Nizza]]-[[Cannes]]
* 13-11: [[Maratona di Beirut]] - {{Bandiera|LIB}} [[Beirut]]
* 13-11: Maratona di Istanbul - {{Bandiera|TUR}} [[Istanbul]]
* 13-11: Maratona di Saitama - {{Bandiera|JPN}} [[Saitama]]
* 20-11: Maratona di Valencia - {{Bandiera|ESP}} [[Valencia]]
* 20-11: Mezza maratona di Boulogne-Billancourt - {{Bandiera|FRA}} [[Boulogne-Billancourt]]
* 20-11: Mezza maratona di Delhi - {{Bandiera|IND}} [[Nuova Delhi]]
* 27-11: Cross Internacional de la Constitucion de Alcobendas - {{Bandiera|ESP}} [[Alcobendas]]
:::::'''''Dicembre 2016'''''
[[Categoria:Epilessie]]
* 4-12: [[Maratona di Fukuoka]] - {{Bandiera|JPN}} [[Fukuoka]]
[[Categoria:Lobo temporale]]
* 4-12: Maratona di Singapore - {{Bandiera|SIN}} [[Singapore]]
[[Categoria:Neurologia]]
* 11-12: Maratona di Canton - {{Bandiera|CHN}} [[Canton]]
* 18-12: Corrida Internationale de Houilles - {{Bandiera|FRA}} [[Houilles]]
* 31-12: [[San Silvestro Vallecana]] - {{Bandiera|ESP}} [[Madrid]]
<small>'''''Fonte'': {{cita web|url=http://www.iaaf.org/competition/calendar/|titolo=Calendario ufficiale IAAF|sito=iaaf.org|editore=IAAF|accesso=19 ottobre 2016}}'''</small>
[[en:Temporal lobe epilepsy]]
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