Hyperkinetic Seizures in Insular and Insulo-Opercular Seizure Onset: A Systematic Review

Area of Science:

• Neurology
• Epileptology
• Clinical Neuroscience

Background:

• Hyperkinetic seizures (HKS) represent a complex epilepsy syndrome.
• Understanding the specific origins and clinical features of HKS is crucial for diagnosis and treatment.

Purpose of the Study:

• To delineate the demographics, semiology, etiology, and clinical characteristics of patients with insulo-opercular versus pure insular epilepsy presenting with HKS.

Main Methods:

• A systematic literature review adhering to PRISMA guidelines was conducted across major databases.
• Included studies reported on patients with insular epilepsy and HKS, confirmed by SEEG or subdural recordings, with favorable surgical outcomes.

Main Results:

• Analysis of 14 studies involving 34 patients revealed that 61.8% had pure insular onset epilepsy.
• Focal cortical dysplasia was the predominant etiology (two-thirds of cases).
• Pure insular onset was significantly associated with specific hyperkinetic behaviors, agitation, vocalization, and breathing difficulties compared to insulo-opercular onset.

Conclusions:

• HKS show a higher association with pure insular epilepsy onset.
• Focal cortical dysplasia is a common cause, and distinct hyperkinetic behaviors are more characteristic of pure insular epilepsy.
• Findings are exploratory due to small, heterogeneous samples and study limitations.