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Insular Cortex Epilepsy

  • Manish Jaiswal
Chapter

Abstract

The insular cortex is a special epileptogenic site from which complex partial seizures may arise. Seizure activity in insular epilepsy may simulate temporal, parietal, or other cortical areas. Insular epilepsy has been infrequently reported, and its clinical and electrographic topographies are poorly stated. Electrographic study of the insula is challenging as it is veiled by the frontal and temporal lobes. Therefore, EEG sampling from the insular cortex is difficult. Numbers of the clinical features would advocate temporal lobe epilepsy and in fact, may be the consequence of the spread of the ictal insular discharge straight into the temporal lobe or via arcuate and uncinate bundle fibers. Participation of the insular cortex in temporal lobe epilepsy has also been well-thought-out in the early period of temporal lobe epilepsy surgery. It has been revealed that insular cortex excision in patients with temporal lobe epilepsy did not intensify the better surgical achievement rate in terms of seizure control and that this technique carried out an undesirable morbidity and mortality rates. Conversely, the contribution of the temporal lobe in insular epilepsy has been off-color studied and almost nothing is known about it. Insular epilepsy stakes many clinical features and EEG findings with temporal lobe epilepsy. Brain imaging with MRI is perhaps the main existing tool to discriminate between them. Semiology, electroencephalography, and even surface electrocorticography recordings may misleadingly localize other cortical foci, leading to imprecise diagnosis and treatment. The insula has long been concerned in the 30% failure rate after temporal lobe resections for medial temporal lobe epilepsy (MTLE). The use of insular depth electrodes permits more accurate localization of seizure foci for better outcome of epilepsy surgery.

Keywords

Insula Insular cortex epilepsy Insular lobe seizure Stereo-electroencephalography Depth electrode 

Abbreviations

ECoG

Electrocorticography

EEG

Electroencephalography

FLAIR

Fluid-attenuated inversion recovery

ICE

Insular cortex epilepsy

MCDs

Malformations of cortical development

MRI

Magnetic resonance imaging

MTLE

Medial temporal lobe epilepsy

PET

Positron-emission tomography

SEEG

Stereo-electroencephalography

SISCOM

Subtraction ictal single-photon emission computed tomography coregistered to MRI

SPECT

Single-photon emission computed tomography

TLE

Temporal lobe epilepsy

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryKing George’s Medical UniversityLucknowIndia

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