Temporal Lobe Epilepsy With Dissociation and Hallucinations

Introduction Distinguishing between functional seizures and epilepsy remains a clinical challenge, particularly in the presence of dissociative symptoms and hallucinations. Temporal lobe epilepsy is characterized by emotional disturbances and sensory alterations, which complicates the diagnostic distinction from functional neurological disorders [1] . Case Presentation A 26-year-old woman presented with recurrent seizures characterized by sensory alterations, including olfactory and gustatory changes, as well as anxiety, auditory, and visual hallucinations preceding the episodes. The majority of seizures were associated with dissociative symptoms and triggered by stress. To differentiate between functional and epileptic seizures, the patient was hospitalized in the Department of Psychiatry, where neuropsychological evaluation revealed an anxiety disorder, and treatment was assigned. A sleep electroencephalogram was performed, revealing epileptiform abnormalities in the left temporal region, occasionally extending to the temporofrontal area. Magnetic resonance imaging revealed a cavernoma in the left temporofrontal lobe. A diagnosis of temporal lobe epilepsy was established, and levetiracetam was initiated. The patient was consulted regarding surgical treatment options and subsequently underwent craniotomy with cavernoma resection. Postoperatively, a complication of right superior homonymous quadrantanopia was observed. Two focal impaired awareness seizures occurred after the surgery, with no further epileptic seizures. After surgical treatment, the patient continues levetiracetam and psychiatric treatment, as occasional dissociative episodes persist. Discussion Temporal lobe epilepsy is often linked to dissociative experiences and various psychiatric comorbidities. Ictal activity can manifest through sensory alterations such as déjà vu, depersonalization, and derealization. However, seizure-like episodes triggered by stress may complicate the diagnosis, raising the possibility of coexisting functional seizures. Comprehensive assessment is crucial for accurate diagnosis and treatment [2,3,4]. Conclusions In this case, it is crucial to differentiate between temporal lobe epilepsy and functional seizures, and a multidisciplinary team is essential.