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Insular epilepsy. Similarities to temporal lobe epilepsy. Case report
A Cukiert1, C Forster, M S Andrioli
1Serviço de Cirurgia de Epilepsia, Hospital Brigadeiro, São Paulo.
Arquivos De Neuro-Psiquiatria
|August 1, 1998
Summary
Insular epilepsy, a rare condition, can mimic temporal lobe epilepsy. Surgical removal of a right anterior insular cavernous angioma resulted in seizure freedom for a patient with this condition.
Area of Science:
- Neurology
- Epileptology
- Neurosurgery
Background:
- Insular epilepsy is infrequently reported, with poorly understood clinical and electrographic characteristics.
- Electrographic study of the insula is challenging due to its deep location, obscured by the frontal and temporal lobes.
Observation:
- A 48-year-old woman presented with simple partial autonomic seizures and complex partial seizures with automatisms and left arm paresis.
- Pre-operative EEG indicated a right temporal lobe focus, neuropsychological testing revealed right fronto-temporal dysfunction, and MRI identified a right anterior insular cavernous angioma.
Findings:
- Intraoperative electrocorticography (ECoG) demonstrated independent spiking in the insula and temporal lobe, with insular spikes spreading to the temporal lobe.
- Resection of the cavernous angioma and surrounding gliotic tissue led to persistent, though reduced, independent insular and temporal spiking post-surgery.
- The patient achieved complete seizure freedom following the surgical intervention.
Implications:
- Insular epilepsy may present with clinical and electroencephalographic features overlapping with temporal lobe epilepsy.
- This case highlights the potential for surgical intervention in managing insular epilepsy originating from cavernous angiomas.
- Further research is needed to elucidate the distinct characteristics and optimal management strategies for insular epilepsy.