[Insular lobe epilepsy. Part 1: semiology]

Area of Science:

• Neuroscience
• Neurology
• Epileptology

Background:

• The insula, or
• Purpose_of_the_Study
• Main_Methods
• Main_Results
• Conclusions

Purpose of the Study:

• To enhance understanding of insular lobe epilepsy (ILE) for improved diagnosis and management.
• To highlight the diagnostic challenges and clinical presentations of ILE.
• To emphasize the role of stereo-electroencephalography (SEEG) in studying insular seizures.

Main Methods:

• Utilized stereo-electroencephalography (SEEG) for safe, chronic intracranial electrode implantation in the insula.
• Performed anatomo-electro-clinical correlation studies for insular origin seizures.
• Reviewed clinical presentations and seizure propagation patterns of ILE.

Main Results:

• SEEG has enabled detailed study of insular seizures, previously limited by deep location.
• ILE presents with diverse symptoms including somatosensory, autonomic, and cervico-laryngeal disturbances.
• Sleep-related hyperkinetic epilepsy (SHE) is a common ILE presentation, often mimicking fronto-mesial seizures.
• Subtle signs like laryngeal constriction or aversive behaviors are key diagnostic clues for insular SHE.
• Insular seizures should be considered in temporal-like epilepsy without clear correlations.

Conclusions:

• ILE is a complex epilepsy syndrome originating from a critical brain hub.
• Accurate diagnosis requires awareness of subtle clinical manifestations and SEEG findings.
• Distinguishing ILE from other epilepsies and non-epileptic conditions is crucial for effective patient care.