Insular and insulo-opercular epilepsy in childhood: an SEEG study

Area of Science:

• Pediatric Neurology
• Epileptology
• Neurosurgery

Background:

• Insular epilepsy in children is poorly understood compared to adults.
• Early surgical intervention can significantly improve cognitive function and quality of life.

Purpose of the Study:

• To investigate the electro-clinical characteristics of insular epilepsy in pediatric patients.
• To evaluate the utility of stereoelectroencephalography (SEEG) and tailored resective surgery in this population.

Main Methods:

• Retrospective analysis of ten children with drug-resistant focal insular epilepsy.
• Stereoelectroencephalography (SEEG) exploration with insular cortex coverage.
• Individually tailored resective surgery including the insula.

Main Results:

• Epilepsy onset typically in the first year, with initial subtle seizures, spasms, and myoclonic seizures.
• Later semiology included neurovegetative signs, asymmetric tonic, and hypermotor seizures (HMS).
• Seven patients achieved Engel class 1 outcome with neuropsychological and behavioral improvements post-surgery.

Conclusions:

• SEEG is feasible and valuable for pediatric drug-resistant insular epilepsy.
• Autonomic symptoms and HMS are key indicators for suspecting insular epilepsy in children.
• Further research with larger cohorts is needed to confirm findings.