synaptic reorganization. this was noted in human tissue in 1974 and in animal models in 1985. in tle, the sprouting mossy fibres are larger than in the normal brain and their connections may be aberrant. mossy fibre sprouting continues from one week to two months after injury.: 416–431 aberrant mossy fibre sprouting may create excitatory feedback circuits that lead to temporal lobe seizures. this is evident in intracellular recordings. stimulation of aberrant mossy fibre areas increases the excitatory postsynaptic potential response. however, aberrant mossy fiber sprouting may inhibit excitatory transmission by synapsing with basket cells which are inhibitory neurons and by releasing gaba and neuropeptide y which are inhibitory neurotransmitters. also, in animal models, granule cell hyper-excitability is recorded before aberrant mossy fibre sprouting has occurred. diagnosis epileptic spike and wave discharges monitored with eeg t1 weighted mri scan of a normal coronal section of human brain with amygdala marked in red. the diagnosis of temporal lobe epilepsy can include the following methods: magnetic resonance imaging (mri), ct scans, positron emission tomography (pet), eeg, and magnetoencephalography. imaging ct scan is useful as the emergency situations when the suspected cause of epilepsy is due to conditions such as intracerebral haemorrhage, or brain abscesses, or when mri imaging is not readily available or there is any contraindications to mri such as the presence of cardiac pacemakers or cochlear implants in the subject's body. ct scan also detect some abnormal calcifications in the brain that is characteristic of diseases such as tuberous sclerosis and sturge–weber syndrome. 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. for patients with medial tle whose seizures remain uncontrolled after trials of several types of anticonvulsants (that is, the epilepsy is intractable), surgical excision of the affected temporal lobe may be considered. surgical interventions epilepsy surgery has been performed since the 1860s and doctors have observed that it is highly effective in producing freedom from seizures. however, it was not until 2001 that a scientifically sound study was carried out to examine the effectiveness of temporal lobectomy. temporal lobe surgery can be complicated by decreased cognitive function. however, after temporal lobectomy, memory function is supported by the opposite temporal lobe; and recruitment of the frontal lobe. cognitive rehabilitation may also help. other treatments where surgery is not recommended, further management options include new (including experimental) anticonvulsants, and vagus nerve stimulation. the ketogenic diet is also recommended for children, and some adults. other options include brain cortex responsive neural stimulators, deep brain stimulation, stereotactic radiosurgery, such as the gamma knife, and laser ablation. effects on society the first to record and catalog the abnormal symptoms and signs of tle was norman geschwind. he found a constellation of symptoms that included hypergraphia, hyperreligiosity, collapse, and pedantism, now called geschwind syndrome. vilayanur s. ramachandran explored the neural basis of the hyperreligiosity seen in tle using the galvanic skin response (gsr), 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 presented two 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. this study was presented as an abstract at a neuroscience conference and referenced in ramachandran's book, phantoms in the brain, but it has never been published in the peer-reviewed scientific press. a study in 2015, reported that intrinsic religiosity and religiosity outside of organized religion were higher in patients with epilepsy than in the control group. lower education level, abnormal background eeg activity, and hippocampal sclerosis have been found to be contributing factors for religiosity in tle. tle has been suggested as a materialistic explanation for the revelatory experiences of prominent religious figures such as abraham, moses, jesus, mohammed, saint paul, joan of arc, saint teresa of ávila, and joseph smith. these experiences are described (in possibly unreliable accounts) as complex interactions with their visions; but possibly (and dependent on the reliability of historical accounts, often made by acolytes) lack the stereotypy, amnestic periods, and automatisms or generalized motor events, which are characteristic of tle. psychiatric conditions with psychotic spectrum symptoms might be more plausible physical explanation of these experiences. it has been suggested that pope pius ix's doctrine of the immaculate conception was influenced by his forensically diagnosed partial epilepsy. in 2016, a case history found that a male temporal lobe epileptic patient experienced a vision of god following a temporal lobe seizure, while undergoing eeg monitoring. the patient reported that god had sent him to the world to "bring redemption to the people of israel". the purported link between tle and religiosity has inspired work by michael persinger and other researchers in the field of neurotheology. others have questioned the evidence for a link between temporal lobe epilepsy and religiosity.