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Choking, asphyxiation and the insular seizure
Nimeshan Geevasinga1, John Stephen Archer2, Karl Ng1
1Department of Neurology, Royal North Shore Hospital and University of Sydney, Sydney, Australia.
Summary
Focal epilepsy originating in the insular cortex can cause choking and strangulation sensations while conscious. This unusual presentation may have normal interictal electroencephalography, requiring clinical awareness.
Area of Science:
- Neuroscience
- Epileptology
- Clinical Neurology
Background:
- The insular cortex, a deep brain region within the Sylvian fissure, possesses complex neural connections.
- Focal epilepsy is characterized by seizures originating from a specific brain area.
Observation:
- Two cases of focal epilepsy originating from the insular cortex were identified.
- Patients experienced ictal symptoms of choking and strangulation while remaining conscious.
Findings:
- Insular cortex epilepsy can manifest with unusual ictal symptoms like choking and strangulation.
- Interictal electroencephalography (EEG) may appear normal in patients with insular epilepsy.
Implications:
- Clinicians must consider insular cortex epilepsy in patients presenting with these specific ictal symptoms.
- The diagnostic approach for focal epilepsy should account for potentially normal interictal EEG findings.
- Awareness of this rare presentation can improve diagnosis and management of insular epilepsy.
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