Case Study: Integrated Management of Temporal Lobe Epilepsy with Antiseizure Medications, Lifestyle Modifications, and Psychosocial Support

Abstract

This case study describes a 28-year-old male with newly diagnosed temporal lobe epilepsy who presented with recurrent focal seizures, memory lapses, and anxiety. The patient was managed with antiseizure medication (levetiracetam), lifestyle modifications, and psychosocial counseling. Over a 12-month follow-up, he achieved significant seizure reduction, improved cognitive stability, and enhanced quality of life. In addition to pharmacological therapy, structured sleep hygiene, stress management, and avoidance of seizure triggers played a crucial role in reducing seizure frequency and improving daily functioning. Regular follow-up, patient education, and counseling helped address anxiety, promote medication adherence, and prevent potential social stigma associated with epilepsy. The case emphasizes the importance of early diagnosis, patient-tailored pharmacotherapy, and holistic multidisciplinary care in managing epilepsy, highlighting that an integrated approach addressing both medical and psychosocial aspects can optimize long-term outcomes and overall well-being.

Introduction

Epilepsy is a chronic neurological disorder affecting approximately 50 million people worldwide and represents one of the most prevalent and impactful neurological conditions. It is characterized by recurrent, unprovoked seizures that result from abnormal, excessive, and synchronous neuronal activity in the brain. Epilepsy can manifest in a wide spectrum, ranging from brief lapses in awareness to severe convulsive episodes, and it is associated with significant morbidity, cognitive impairment, and psychosocial consequences. Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy in adults and is often linked to structural abnormalities such as hippocampal sclerosis. Patients with TLE typically present with focal seizures that may include impaired awareness, automatisms such as lip-smacking or hand movements, déjà vu experiences, and memory disturbances, which can significantly impact daily functioning, academic or occupational performance, and social engagement.

Advances in antiseizure medications (ASMs) have dramatically improved seizure control for many patients, providing a range of therapeutic options with varying mechanisms of action, pharmacokinetics, and side effect profiles. In addition, surgical interventions, including anterior temporal lobectomy, and neurostimulation techniques such as vagus nerve stimulation or responsive neurostimulation, offer alternatives for patients with drug-resistant epilepsy. Despite these advances, many challenges remain. A substantial proportion of patients continue to experience drug-resistant seizures, cognitive deficits, and psychiatric comorbidities such as anxiety and depression. The social and psychological burden of epilepsy, including stigma, discrimination, and limitations on driving or employment, further complicates management. This case underscores the value of an integrated, multidisciplinary approach for TLE, combining pharmacological therapy with lifestyle modifications, psychosocial support, patient education, and regular monitoring. By adopting such a comprehensive strategy, clinicians can optimize seizure control, enhance cognitive function, and improve overall quality of life in young adults living with temporal lobe epilepsy.

Patient Information

• Age / Gender: 28-year-old male
• Occupation: IT professional
• Medical History: Migraine since adolescence
• Surgical History: None significant
• Family History: Uncle with epilepsy
• Social History: Occasional alcohol, high screen time, irregular sleep schedule
• Current Medications: None before presentation
• Chief Complaints: Recurrent episodes of sudden staring, lip-smacking, memory lapses, and post-event confusion for 4 months

Clinical Findings

Symptoms

• Recurrent focal seizures with impaired awareness (1–2 per week)
• Aura: rising epigastric sensation, déjà vu episodes
• Memory lapses, daytime fatigue
• Anxiety and fear of social situations due to seizure unpredictability

Physical & Neurological Examination

• Vitals: BP 124/82 mmHg, HR 84 bpm, afebrile
• General: Normal
• Neuro Exam: Normal strength, reflexes, coordination
• Cognitive testing: Mild deficits in short-term memory recall

Timeline

• Initial Diagnosis (March 2022):
   Presented with recurrent focal seizures and cognitive symptoms. EEG showed left temporal epileptiform discharges; MRI revealed hippocampal sclerosis.
• Initiation of Therapy (April 2022):
   Started on levetiracetam 500 mg BID; advised seizure precautions and sleep hygiene.
• Symptomatic Improvement (June 2022):
   Seizure frequency reduced from weekly to monthly. Anxiety addressed with counseling sessions.
• Dose Adjustment (September 2022):
   Levetiracetam titrated to 1000 mg BID due to breakthrough seizures.
• Sustained Control (March 2023):
   Patient remained seizure-free for 6 months, with improved mood, memory stabilization, and better work performance.

Diagnostic Assessment

Laboratory Findings

• CBC, LFTs, RFTs: Within normal limits
• Vitamin D: Mildly low (supplemented)

Imaging

• MRI Brain: Left hippocampal sclerosis with temporal lobe atrophy
• EEG: Left temporal sharp waves, seizure focus confirmed

Therapeutic Intervention

Step 1 – Acute Seizure Management

• Education on seizure first-aid
• Safety precautions (avoid swimming alone, driving restrictions)

Step 2 – Pharmacological Therapy

• Levetiracetam 500 mg BID → titrated to 1000 mg BID
• Vitamin D supplementation

Step 3 – Lifestyle & Psychosocial Interventions

• Structured sleep hygiene, reduced screen time
• Stress management with mindfulness techniques
• Counseling sessions to address seizure-related anxiety and stigma

Challenges Faced

• Initial irritability and mood swings with levetiracetam
• Patient’s fear of job loss due to disclosure of diagnosis
• Adjustment to lifestyle changes (alcohol and late-night work avoidance)

Follow-Up and Outcomes

• Seizure Control: 6 months seizure-free by end of first year
• Cognitive Function: Improved concentration and memory scores
• Quality of Life: Anxiety reduced, patient resumed full work responsibilities
• Social Outcome: Patient engaged in epilepsy awareness support groups

Discussion

This case illustrates the successful management of temporal lobe epilepsy with a combination of ASMs, lifestyle interventions, and psychosocial support. Levetiracetam is a widely used first-line ASM due to its favorable tolerability and broad-spectrum efficacy. Compared with older agents, it has fewer drug–drug interactions and can be titrated more quickly, making it especially suitable for younger adults with active lifestyles. Its predictable pharmacokinetic profile allows for once- or twice-daily dosing, improving adherence and reducing the risk of breakthrough seizures. Additionally, levetiracetam has a low risk of cognitive impairment and minimal impact on mood, which is particularly beneficial for patients concerned about side effects affecting daily functioning, work, or academic performance.

The International League Against Epilepsy (ILAE) guidelines (2017) recommend individualized therapy, with consideration of ASM side effects, comorbidities, and psychosocial factors. Personalized therapy ensures that treatment not only controls seizures but also addresses mood disturbances, cognitive function, and overall quality of life. Studies (French JA et al., Lancet Neurol, 2017) confirm levetiracetam’s efficacy in focal epilepsy, demonstrating significant reductions in seizure frequency and good tolerability across diverse patient populations, including those with coexisting anxiety or depressive symptoms.

Non-pharmacological strategies such as stress management, adherence support, cognitive behavioral therapy, and seizure precautions significantly improve long-term outcomes. For example, structured sleep schedules, avoidance of seizure triggers, relaxation techniques, and regular physical activity are proven to reduce relapse rates, enhance cognitive performance, and promote emotional well-being. Multidisciplinary care involving neurologists, psychologists, occupational counselors, social workers, and patient support groups is critical in addressing the multifaceted impact of epilepsy, empowering patients to achieve both medical stability and social reintegration while improving overall physical and mental health outcomes.

Key Takeaways

• Levetiracetam is effective in controlling focal seizures with a favorable safety profile.
• Lifestyle changes (sleep, stress, alcohol avoidance) reduce seizure triggers.
• Psychosocial counseling alleviates anxiety and improves adherence.
• Regular monitoring and multidisciplinary collaboration enhance quality of life.

Patient’s Perspective

“I was very worried about losing control during seizures, especially at work. With the medicines and counseling, my seizures stopped, and I feel more confident. Learning to manage stress and getting family support made a huge difference.”

Conclusion

This case demonstrates that integrated management combining antiseizure medication, lifestyle modifications, and psychosocial care can lead to sustained seizure freedom, cognitive stability, and improved quality of life in patients with temporal lobe epilepsy. By addressing both the biological and psychosocial dimensions of epilepsy, treatment outcomes extend beyond mere seizure control to encompass mental health, daily functioning, and social integration. Long-term success often depends on consistent medication adherence, proactive lifestyle adjustments such as adequate sleep and stress management, and ongoing counseling to reduce anxiety, depression, and stigma. Personalized, multidisciplinary approaches involving neurologists, psychologists, and allied health professionals remain central to optimal neurological care, ensuring that patients not only achieve medical stability but also regain confidence, independence, and an enhanced sense of well-being.

References

• French JA, Perucca E, et al. (2017). New and emerging treatments for epilepsy. Lancet Neurol. https://doi.org/10.1016/S1474-4422(17)30179-6
• Kanner AM. (2016). Management of psychiatric and neurological comorbidities in epilepsy. Nat Rev Neurol. https://doi.org/10.1038/nrneurol.2016.70
• Fisher RS, et al. (2017). ILAE classification of seizures: 2017 update. Epilepsia. https://doi.org/10.1111/epi.13670
• Perucca P, Gilliam FG. (2012). Adverse effects of antiepileptic drugs. Lancet Neurol. https://doi.org/10.1016/S1474-4422(12)70153-9 

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