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Chapter 7 - Clinical Presentation of Insulo-Opercular Epilepsy in Adults

from Section 2 - The Spectrum of Epilepsies Involving the Insula

Published online by Cambridge University Press:  09 June 2022

By
Laurence Martineau ,
Dang Khoa Nguyen  and
Jean Isnard
Edited by
Dang Nguyen ,
Jean Isnard  and
Philippe Kahane
Dang Nguyen
Affiliation:
Université de Montréal
Jean Isnard
Affiliation:
Claude Bernard University Lyon
Philippe Kahane
Affiliation:
Grenoble-Alpes University Hospital
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Summary

Insular lobe seizures (ILS) may present with several subjective and objective symptoms. Somatosensory and viscerosensory symptoms, notably paresthesia and laryngeal constriction, are symptoms frequently encountered with ILS. Other manifestations may become only evident after the ictal discharge spreads to extra-insular structures. Depending on propagation pathways, ILS exhibit two main clinical patterns: (1) a perisylvian /temporo-perisylvian pattern and (2) a frontal-like pattern. Other miscellaneous clinical presentations include epileptic spasms, ecstatic, gelastic, reflex, and autonomic seizures.

Keywords

insular lobe seizureinsular lobe epilepsysemiologySEEGelectrical stimulationsclinical symptoms
Type
Chapter
Information
Insular Epilepsies , pp. 67 - 81
Publisher: Cambridge University Press
Print publication year: 2022

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References

Ghaziri, J, Tucholka, A, Girard, G, Boucher, O, Houde, JC, Descoteaux, M, et al. Subcortical structural connectivity of insular subregions. Sci Rep 2018;8(1):8596.Google Scholar
Mazzola, L, Mauguiere, F, Isnard, J. Electrical stimulations of the human insula: Their contribution to the ictal semiology of insular seizures. J Clin Neurophysiol 2017;34(4):307–314.CrossRefGoogle Scholar
Nguyen, DK, Nguyen, DB, Malak, R, Leroux, JM, Carmant, L, Saint-Hilaire, JM, et al. Revisiting the role of the insula in refractory partial epilepsy. Epilepsia 2009;50(3):510–520.CrossRefGoogle ScholarPubMed
Pugnaghi, M, Meletti, S, Castana, L, Francione, S, Nobili, L, Mai, R, et al. Features of somatosensory manifestations induced by intracranial electrical stimulations of the human insula. Clin Neurophysiol 201;122(10):2049–2058.Google Scholar
Afif, A, Minotti, L, Kahane, P, Hoffmann, D. Anatomofunctional organization of the insular cortex: A study using intracerebral electrical stimulation in epileptic patients. Epilepsia 2010;51(11):2305–2315.Google Scholar
Afif, A, Minotti, L, Kahane, P, Hoffmann, D. Middle short gyrus of the insula implicated in speech production: Intracerebral electric stimulation of patients with epilepsy. Epilepsia 2010;51(2):206–213.CrossRefGoogle ScholarPubMed
Isnard, J, Hagiwara, K, Montavont, A, Catenoix, H, Mazzola, L, Ostrowsky-Coste, K, et al. Semiology of insular lobe seizures. Rev Neurol 2019;175(3):144–149.Google Scholar
Obaid, S, Zerouali, Y, Nguyen, DK. Insular epilepsy: semiology and non-invasive investigations. J Clin Neurophysiol 2017;34(4):315–323.Google Scholar
Jobst, BC, Gonzalez-Martinez, J, Isnard, J, Kahane, P, Lacuey, N, Lahtoo, SD, et al. The insula and its epilepsies. Epilepsy Curr 2019;19(1):11–21.Google Scholar
Ryvlin, P. Avoid falling into the depths of the insular trap. Epileptic Disord 2006;8 (suppl 2):S37–S56.Google ScholarPubMed
Ostrowsky, F, Isnard, J, Ryvlin, P, Guénot, M, Fischer, C, Mauguière, F. Functional mapping of the insular cortex: Clinical implication in temporal lobe epilepsy. Epilepsia 2000;41(6):681–6.Google Scholar
Barba, C, Minotti, L, Job, AS, Kahane, P. The insular in temporal plus epilepsy. J Clin Neurophysiol 2017;34(4):324–327.Google Scholar
Mazzola, L, Isnard, J, Mauguière, F. Somatosensory and pain responses to stimulation of the second somatosensory area (SII) in humans. A comparison with SI and insular responses. Cereb Cortex 2006;16(7):960–968.CrossRefGoogle Scholar
Montavont, A, Mauguière, F, Mazzola, L, Garcia-Larrea, L, Catenoix, H, Ryvlin, P, et al. On the origin of painful somatosensory seizures. Neurology 2015;84(6):594–601.CrossRefGoogle ScholarPubMed
Bouthillier, A, Nguyen, DK. Epilepsy surgeries requiring an operculoinsular cortectomy: operative technique and results. Neurosurgery 2017;81(4):602–612.Google Scholar
Afif, A, Hoffmann, Minotti L, Benabid, AL, Kahane, P. Middle short gyrus of the insula implicated in pain processing. Pain 2008;138(3):546–555.Google Scholar
Dimova, P, De Palma, L, A-S, Job-Chapron, Minotti, L, Hoffmann, D, Kahane, P. Radiofrequency thermocoagulation of the seizure-onset zone during stereoelectroencephalography. Epilepsia 2017; 58(3):381–392.Google Scholar
Isnard, J, Guénot, M, Sindou, M, Mauguière, F. Clinical manifestations of insular lobe seizures: a stereoelectroencephalographic study. Epilepsia 2004;45(9):1079–1090.Google Scholar
Gras-Combe, G, Minotti, L, Hoffmann, D, Krainik, A, Kahane, P, Chabardes, S. Surgery for nontumoral insular epilepsy explored by stereoelectroencephalography. Neurosurgery 2016;79(4):578–588.Google Scholar
Proserpio, P, Cossu, M, Francione, S, Tassi, L, Mai, R, Didato, G, et al. Insular-opercular seizures manifesting with sleep-related paroxysmal motor behaviors: a stereo-EEG study. Epilepsia 2011;52(10):1781–1791.Google Scholar
Isnard, J, Guénot, M, Ostrowsky, K, Sindou, M, Mauguière, F. The role of the insular cortex in temporal lobe epilepsy. Ann Neurol 2000;48(4):614–623.Google Scholar
Catenoix, H, Isnard, J, Guénot, M, Petit, J, Remy, C, Mauguière, F. The role of the anterior insular cortex in ictal vomiting: a stereotactic electroencephalography study. Epilepsy Behav 2008;13(3):560–563.CrossRefGoogle ScholarPubMed
Ferri, L, Bisulli, F, Nobili, L, Tassi, L, Licchetta, L, Mostacci, B, et al. Auditory aura in nocturnal frontal lobe epilepsy: a red flag to suspect an extra-frontal epileptogenic zone. Sleep Med 2014;15(11):1417–1423.Google Scholar
Thompson, SA, Alexopoulos, A, Bingaman, W, Gonzalez-Martinez, J, Bulacio, J, Nair, D, et al. Auditory aura in frontal opercular epilepsy: Sounds from afar. Epileptic Disord 2015;17(2):150–155.Google Scholar
Blauwblomme, T, Kahane, P, Minotti, L, Grouiller, F, Krainik, A, Vercueil, L, et al. Multimodal imaging reveals the role of gamma activity in eating-reflex seizures. J Neurol Neurosurg Psychiatry 2011;82(10):1171–1173.CrossRefGoogle ScholarPubMed
Wang, X, Hu, W, McGonigal, A, Zhang, C, Sang, L, Zhao, B, et al. Electroclinical features of insulo-opercular epilepsy: An SEEG and PET study. Ann Clin Transl Neurol 2019;6(7):1165–1177.Google Scholar
Mindruta, I, Minotti, L, Montavont, A, Hoffmann, D, Chabardes, S, Guenot, M, et al. Clinical semiology and surgery outcome of seizures originating in the peri-Sylvian operculum based on stereo-electroencephalografic (SEEG) studies. Epilepsy Curr 2012;13(suppl 1):215.Google Scholar
Malîia, MD, Donos, C, Barborica, A, Popa, I, Ciurea, J, Cinatti, S, et al. Functional mapping and effective connectivity of the human operculum. Cortex 2018;109:303–321.Google Scholar
Tinuper, P, Bisulli, F, Cross, JH, Hesdorffer, D, Kahane, P, Nobili, L, et al. Definition and diagnostic criteria of sleep-related hypermotor epilepsy. Neurology 2016;86(19):1834–1842.CrossRefGoogle ScholarPubMed
Ryvlin, P, Rheims, S, Risse, G. Nocturnal frontal lobe epilepsy. Epilepsia 2006;47(suppl 2):83–86.Google Scholar
Proserpio, P, Cossu, M, Francione, S, Gozzo, F, Lo Russo, G, Mai, R, et al. Epileptic motor behaviors during sleep: Anatomo-electro-clinical features. Sleep Med 2011;12 (suppl 2):S33–S38.Google Scholar
Hagiwara, K, Jung, J, Bouet, R, Abdallah, C, Guénot, M, Garcia-Larrea, L, et al. How can we explain the frontal presentation of insular lobe epilepsy? The impact of non-linear analysis of insular seizures. Clin Neurophysiol 2017;128 (5):780–791.Google Scholar
Ryvlin, P, Minotti, L, Demarquay, G, Hirsch, E, Arzimanoglou, A, Hoffman, D, et al. Nocturnal hypermotor seizures, suggesting frontal lobe epilepsy, can originate in the insula. Epilepsia 2006;47:755–765.Google Scholar
Nobili, L, Francione, S, Mai, R, Cardinale, F, Castana, L, Tassi, L, et al. Surgical treatment of drug-resistant nocturnal frontal lobe epilepsy. Brain 2007;130:561–573.Google Scholar
Dobesberger, J, Ortler, M, Unterberger, I, Walser, G, Falkenstetter, T, Bodner, T, et al. Successful surgical treatment of insular epilepsy with nocturnal hypermotor seizures. Epilepsia 2008;49(1):159–162.Google Scholar
Levy, A, Yen Tran, TP, Boucher, O, Bouthillier, A, Nguyen, DK. Operculo-insular epilepsy: scalp and intracranial electroencephalographic findings. J Clin Neurophysiol 2017;34(5):438–447.Google Scholar
Gschwind, M, Picard, F. Ecstatic epileptic seizures: A glimpse into the multiple roles of the insula. Front Behav Neurosci 2016;10:21.Google Scholar
Tran, TP, Truong, VT, Wilk, M, Tayah, T, Bouthillier, A, Mohamed, I, et al. Different localizations underlying cortical gelastic epilepsy: case series and review of literature. Epilepsy Behav 2014;35:34–41.Google Scholar
Yan, H, Liu, C, Yu, T, Yu, K, Xu, C, Wang, X, et al. Mirth and laughter induced by electrical stimulation of the posterior insula. J Clin Neurosci 2019;61:269–271.Google Scholar
Caruana, F, Avanzini, P, Gozzo, F, Francione, S, Cardinale, F, Rizzolatti, G. Mirth and laughter elicited by electrical stimulation of the human anterior cingulate cortex. Cortex 2015; 71:323–331.Google Scholar
Xiao, H, Tran, TP, Petrin, M, Boucher, O, Mohamed, I, Bouthillier, A, et al. Reflex operculoinsular seizures. Epileptic Disord 2016;18(1):19–25.CrossRefGoogle ScholarPubMed
Kurth, F, Zilles, K, Fox, PT, Laird, AR, Eickhoff, SB. A link between the systems: Functional differentiation and integration within the human insula revealed by meta-analysis. Brain Struct Funct 2010;214(5–6):519–534.Google Scholar
Britton, JW. Seizures and syncope: Anatomic basis and diagnostic considerations. Clin Auton Res 2006;16(1):18–28.CrossRefGoogle ScholarPubMed
Lacuey, N, Zonjy, B, Theerannaew, W, Loparo, KA, Tatsuoka, C, Sahadevan, J, et al. Left-insular damage, autonomic instability, and sudden unexpected death in epilepsy. Epilepsy Behav 2016;55:170–173.Google Scholar
Lacuey, N, Garg, V, Bangert, B, Hampson, JP, Miller, J, Lhatoo, S. Insular resection may lead to autonomic function changes. Epilepsy Behav 2019;97:260–264.Google Scholar
Oppenheimer, SM, Gelb, A, Girvin, JP. Cardiovascular effects of human insular cortex stimulation. Neurology 1992;42(9):1727–1732.CrossRefGoogle ScholarPubMed
Al-Otaibi, F, Wong, SW, Shoemaker, JK, Parrent, AG, Mirsattari, SM. The cardioinhibitory responses of the right posterior insular cortex in an epileptic patient. Stereotact Funct Neurosurg 2010;88(6):390–397.Google Scholar
Chouchou, F, Mauguière, F, Vallayer, O, Catenoix, H, Isnard, J, Montavont, A, et al. How the insula speaks to the heart: cardiac responses to insular stimulations in humans. Hum Brain Mapp 2019;40(9):2611–2622.Google Scholar
Lanz, M, Oehl, B, Brandt, A, Schulze-Bonhage, A. Seizure induced cardiac asystole in epilepsy patients undergoing long term video-EEG monitoring. Seizure 2011;20(2):167–172.Google Scholar
Britton, JW, Ghearing, GR, Benarroch, EE, Cascino, GD. The ictal bradycardia syndrome: localization and lateralization. Epilepsia 2006;47(4):737–744.Google Scholar
Tényi, D, Gyimesi, C, Kupó, P, Horváth, R, Bóné, B, Barsi, P, et al. Ictal asystole: A systematic review. Epilepsia 2017;58(3):356–362.Google Scholar
Catenoix, H, Mauguière, F, Guénot, M, Isnard, J, Ryvlin, P. Recording the insula during ictal asystole. Int J Cardiol 2013;169(2):28–30.Google Scholar

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