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Role of the Insula in Temporal Lobe Epilepsy Surgery Failure

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Island of Reil (Insula) in the Human Brain

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Abstract

Despite decades of research, the rate of epilepsy surgery failures in patients with drug refractory seizures remains important (30% for temporal and 50% for frontal lobe surgeries). Inaccurate localization or delimitation of the epileptic focus are the two most likely explanations and might be due to misleading clinical symptoms (as a result of local or propagated epileptic activity to other brain areas within the epileptic network) as well as limitations of standard localization tools. Indeed, MRI fails to identify an epileptogenic lesion in 25% of temporal and 45% of frontal epilepsy cases; scalp EEG, SPECT, and PET scans have limited spatial and/or temporal resolution; and although intracranial EEG electrodes are closer to bioelectric sources of epileptic activity, the focus might not be sampled if not initially felt to be an area of suspected epileptogenicity.

Until recently, the insula has largely been ignored as a possible site of seizures. Using invasive sampling of the insula with depth electrodes, we and others have showed that in some cases failure to recognize insular seizures was responsible for their poor postoperative seizure outcome. Indeed, since the insula is highly connected with the frontal, temporal, and parietal lobes, seizures arising from the insula may be difficult to distinguish from those originating from these other areas and are thus most of the time overlooked. In this chapter, we will review the existing literature supporting the role of the insula as a cause of epilepsy surgery failures and provide illustrative cases.

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Abbreviations

EEG:

Electroencephalography

MEG:

Magnetoencephalography

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

SEEG:

Stereoencephalography

SPECT:

Single-photon emission computed tomography

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Authors and Affiliations

  1. Service de Neurochirurgie, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Vamsi Krishna Yerramneni M.D. & Alain Bouthillier M.D., M.Sc.

  2. Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Dang Khoa Nguyen M.D., Ph.D.

  3. Département de Neurosciences, Université de Montréal, Montreal, QC, Canada

    Dang Khoa Nguyen M.D., Ph.D.

  4. Service de Neurologie, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Dang Khoa Nguyen M.D., Ph.D.

Authors
  1. Vamsi Krishna Yerramneni M.D.
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  2. Alain Bouthillier M.D., M.Sc.
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  3. Dang Khoa Nguyen M.D., Ph.D.
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Corresponding author

Correspondence to Dang Khoa Nguyen M.D., Ph.D. .

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Editors and Affiliations

  1. Adnan Menderes University, School of Medicine , Aydın, Turkey

    Mehmet Turgut

  2. Ege University, Department of Anatomy, Izmir, Turkey

    Canan Yurttaş

  3. Seattle Science Foundation, Seattle, Washington, USA

    R. Shane Tubbs

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Yerramneni, V.K., Bouthillier, A., Nguyen, D.K. (2018). Role of the Insula in Temporal Lobe Epilepsy Surgery Failure. In: Turgut, M., Yurttaş , C., Tubbs, R. (eds) Island of Reil (Insula) in the Human Brain. Springer, Cham. https://doi.org/10.1007/978-3-319-75468-0_30

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