Scientific article

Invasive Investigation of Insular Cortex Epilepsy

Published inJournal of Clinical Neurophysiology, vol. 34, no. 4, p. 328-332
Publication date2017

Invasive long-term EEG investigations of the insula have been performed since the mid-nineties in an expanding range of focal epilepsies suspected to involve the insular cortex. The various clinical forms of insular epilepsies were delineated during the last 2 decades, and include the following presentations: perisylvian epilepsy, temporal plus epilepsy, sleep hypermotor epilepsy, MRI-negative frontal and parietal lobe epilepsies, and insular lesions. In fact, a majority of complex stereoelectroencephalography procedures will include at least one electrode targeting the insula. Stereoelectroencephalography is currently the preferred method to investigate the insula, using orthogonal, oblique, or a combination of both trajectories, with no evidence of higher risk of intracranial bleeding than in other brain regions. Orthogonal trajectories allow to sample the overlaying opercula, while oblique trajectories offer a better sampling of the insular cortex. Intrainsular ictal EEG pattern are often characterized by a prolonged focal discharge restricted to one of the five insular gyri, militating for a dense enough sampling of the insular cortex in suspected insular epilepsies. Stereoelectroencephalography offers the potential to perform thermolesion of insular epileptogenic zones which, together with MRI-guided laser ablation, represent a possibly safer alternative treatment to open-skull surgical resection of the insula.

Citation (ISO format)
RYVLIN, Philippe, PICARD, Fabienne. Invasive Investigation of Insular Cortex Epilepsy. In: Journal of Clinical Neurophysiology, 2017, vol. 34, n° 4, p. 328–332. doi: 10.1097/WNP.0000000000000395
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Article (Published version)
ISSN of the journal0736-0258

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