Anterior insula activations in perceptual paradigms: often observed but barely understood

Anterior insular cortex is among the non-sensory brain regions most commonly found activated in functional brain imaging studies on visual and auditory perception. However, most of these studies do not explicitly address the functional role of this specific brain region in perception, but rather report its activation as a by-product. Here, we attempt to characterize the involvement of anterior insular cortex in various perceptual paradigms, including studies of visual awareness, perceptual decision making, cross-modal sensory processes and the role of spontaneous neural activity fluctuations in perception. We conclude that anterior insular cortex may be associated with perception in that it underpins heightened alertness of either stimulus- or task-driven origin, or both. Such a mechanism could integrate endogenous and exogenous functional demands under the joint criterion of whether they challenge an individual's homeostasis.