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Insular epilepsy surgery.

Pramote Laoprasert1, Jeffrey G Ojemann2, Michael H Handler3

  • 1Division of Neurology, Department of Pediatrics, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A.

Epilepsia
|April 8, 2017
PubMed
Summary
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Insular epilepsy, a rare condition, can cause seizures mimicking other types and lead to surgical failure. Accurate diagnosis via intracranial recordings and surgical resection offer effective management for this challenging epilepsy syndrome.

Area of Science:

  • Neurology
  • Neurosurgery
  • Epileptology

Background:

  • Insular epilepsy, recognized for nearly 70 years, is increasingly acknowledged as a cause of surgical failure in epilepsy operations.
  • It can present with symptoms overlapping frontal, parietal, or temporal lobe seizures, complicating diagnosis.

Purpose of the Study:

  • To review the historical awareness, diagnostic techniques, and surgical management of insular epilepsy.
  • To highlight the importance of considering insular epilepsy in specific clinical presentations.

Main Methods:

  • Review of historical literature and clinical case series.
  • Discussion of diagnostic modalities including extraoperative intracranial recordings.
  • Description of surgical techniques such as stereo-electroencephalography (EEG) and craniotomy with electrode implantation.
Keywords:
Insular epilepsyInsular epilepsy surgeryTemporal lobe plus epilepsy

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Main Results:

  • Insular epilepsy should be suspected when seizures present with early somatosensory, visceral, and motor symptoms.
  • Extraoperative intracranial recordings, including stereo-EEG, are crucial for localizing seizure onset in the insula.
  • Surgical resection of the identified insular epileptic focus can achieve good outcomes.

Conclusions:

  • Insular epilepsy is an important consideration in refractory epilepsy cases, particularly those with atypical seizure semiology.
  • Accurate diagnosis relies on advanced intracranial EEG monitoring.
  • Surgical intervention for insular epilepsy offers a viable treatment option with acceptable risks and potential for success.