However, CT scan is not sensitive or specific enough when compared in MRI in detecting the common causes of epilepsy such as small tumours, vascular malformations, abnormalities of cerebral cortex development, or abnormalities in the medial part of the temporal lobe.MRI is the imaging choice when assessing those with epilepsy. In newly diagnosed epilepsy, MRI can detect brain lesion in up to 12 to 14% of the cases. However, for those with chronic epilepsy, MRI can detect brain lesion in 80% of the cases. However, in cases where there is definite clinical and EEG diagnosis of idiopathic generalized epilepsy, or Rolandic epilepsy, MRI scan is not needed. Differential diagnosis
Other medical conditions with similar symptoms include panic attacks, psychosis spectrum disorders, tardive dyskinesia, and occipital lobe epilepsy. Treatments
Anticonvulsants
Many anticonvulsant oral medications are available for the management of temporal lobe seizures. Most anticonvulsants function by decreasing the excitation of neurons, for example, by blocking fast or slow sodium channels or by modulating calcium channels; or by enhancing the inhibition of neurons, for example by potentiating the effects of inhibitory neurotransmitters like GABA.In TLE, the most commonly used older medications are phenytoin, carbamazepine, primidone, valproate, and phenobarbital. Newer drugs, such as gabapentin, topiramate, levetiracetam, lamotrigine, pregabalin, tiagabine, lacosamide, and zonisamide promise similar effectiveness, with possibly fewer side-effects. Felbamate and vigabatrin are newer, but can have serious adverse effects so they are not considered as first-line treatments.Up to one third of patients with medial temporal lobe epilepsy will not have adequate seizure control with medication alone.
Meningism is a set of symptoms similar to those of meningitis but not caused by meningitis. Whereas meningitis is inflammation of the meninges (membranes that cover the central nervous system), meningism is caused by nonmeningitic irritation of the meninges, usually associated with acute febrile illness, especially in children and adolescents. Meningism involves the triad (3-symptom syndrome) of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache. It therefore requires differentiating from other CNS problems with similar symptoms, including meningitis and some types of intracranial hemorrhage. Related clinical signs include Kernigs sign and three signs all named Brudzinskis sign. Although nosologic coding systems, such as ICD-10 and MeSH, define meningism/meningismus as meningitis-like but in fact not meningitis, many physicians use the term meningism in a loose sense clinically to refer to any meningitis-like set of symptoms before the cause is definitively known. In this sense, the word implies "suspected meningitis". The words meningeal symptoms can be used instead to avoid ambiguity, thus reserving the term meningism for its strict sense. Signs and symptoms
The main clinical signs that indicate meningism are nuchal rigidity, Kernigs sign and Brudzinskis signs. None of the signs are particularly sensitive; in adults with meningitis, nuchal rigidity was present in 30% and Kernigs or Brudzinskis sign only in 5%. Nuchal rigidity
Nuchal rigidity is the inability to flex the neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.