Skip to main content
SpringerLink
Log in

Insular Cortex Epilepsy

  • Chapter
  • First Online:
Island of Reil (Insula) in the Human Brain

  • 988 Accesses

Abstract

The insular cortex is a special epileptogenic site from which complex partial seizures may arise. Seizure activity in insular epilepsy may simulate temporal, parietal, or other cortical areas. Insular epilepsy has been infrequently reported, and its clinical and electrographic topographies are poorly stated. Electrographic study of the insula is challenging as it is veiled by the frontal and temporal lobes. Therefore, EEG sampling from the insular cortex is difficult. Numbers of the clinical features would advocate temporal lobe epilepsy and in fact, may be the consequence of the spread of the ictal insular discharge straight into the temporal lobe or via arcuate and uncinate bundle fibers. Participation of the insular cortex in temporal lobe epilepsy has also been well-thought-out in the early period of temporal lobe epilepsy surgery. It has been revealed that insular cortex excision in patients with temporal lobe epilepsy did not intensify the better surgical achievement rate in terms of seizure control and that this technique carried out an undesirable morbidity and mortality rates. Conversely, the contribution of the temporal lobe in insular epilepsy has been off-color studied and almost nothing is known about it. Insular epilepsy stakes many clinical features and EEG findings with temporal lobe epilepsy. Brain imaging with MRI is perhaps the main existing tool to discriminate between them. Semiology, electroencephalography, and even surface electrocorticography recordings may misleadingly localize other cortical foci, leading to imprecise diagnosis and treatment. The insula has long been concerned in the 30% failure rate after temporal lobe resections for medial temporal lobe epilepsy (MTLE). The use of insular depth electrodes permits more accurate localization of seizure foci for better outcome of epilepsy surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ECoG:

Electrocorticography

EEG:

Electroencephalography

FLAIR:

Fluid-attenuated inversion recovery

ICE:

Insular cortex epilepsy

MCDs:

Malformations of cortical development

MRI:

Magnetic resonance imaging

MTLE:

Medial temporal lobe epilepsy

PET:

Positron-emission tomography

SEEG:

Stereo-electroencephalography

SISCOM:

Subtraction ictal single-photon emission computed tomography coregistered to MRI

SPECT:

Single-photon emission computed tomography

TLE:

Temporal lobe epilepsy

References

  1. Guillaume MMJ, Mazars G. Cinq cas de foyers épileptogènes insulaires opérés. Soc Française Neurol. 1949;a:766–9.

    Google Scholar 

  2. Guillaume MMJ, Mazars G. Technique de resection de l’insula dans les epilepsies insulaires. Rev Neurol. 1949;81:900–3.

    Google Scholar 

  3. Penfield W, Jasper WW, editors. Epilepsy and the functional anatomy of the human brain. Boston: Little, Brown; 1954.

    Google Scholar 

  4. Guillaume MMJ, Mazars G, Mazars Y. Indications chirurgicales dans les epilepsies dites “temporalis”. Rev Neurol. 1953;88:461–501.

    PubMed  CAS  Google Scholar 

  5. Penfield W, Faulk ME. The insula: further observations on its function. Brain. 1955;78:445–70.

    Article  CAS  PubMed  Google Scholar 

  6. Silfvenius H, Gloor P, Rasmussen T. Evaluation of insular ablation in surgical treatment of temporal lobe epilepsy. Epilepsia. 1964;5:307–20.

    Article  CAS  PubMed  Google Scholar 

  7. Hatashita S, Sakakibara T, Ishii S. Lipoma of the insula: case report. J Neurosurg. 1983;58(2):300.

    Article  CAS  PubMed  Google Scholar 

  8. Roper SN, Levesque MF, Sutherling WW. Surgical treatment of partial epilepsy arising from the insular cortex: report of two cases. J Neurosurg. 1993;79:266–9.

    Article  CAS  PubMed  Google Scholar 

  9. Duffau H, Capelle L, Lopes M. Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy. Acta Neurochir. 2002;144:563–72.

    Article  CAS  PubMed  Google Scholar 

  10. Isnard J, Guenot M, Ostrowsky K. The role of the insular cortex in temporal lobe epilepsy. Ann Neurol. 2000;48:614–23.

    Article  CAS  PubMed  Google Scholar 

  11. Williamson D, Engel J, Munari C. Anatomic classification of localization-related epilepsy. In: Engel J, Pedley T, editors. Epilepsy. Philadelphia: Lippincott-Raven; 1997. p. 2405–26.

    Google Scholar 

  12. Prats JM, Garaizar C, Garcia-Nieto ML. Opercular epileptic syndrome: an unusual form of benign partial epilepsy in childhood. Rev Neurol. 1999;29:375–80.

    PubMed  CAS  Google Scholar 

  13. Bancaud J. Clinical symptomatology of epileptic seizures of temporal origin. Rev Neurol. 1987;143:392–400.

    PubMed  CAS  Google Scholar 

  14. Guenot M, Isnard J, Ryvlin P. Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method: StereoElectroEncephaloGraphy: indications, results, complications and therapeutic applications in a series of 100 consecutive cases. Stereotact Funct Neurosurg. 2001;77:29–32.

    Article  CAS  PubMed  Google Scholar 

  15. Talairach J, Tournoux P. Co-planar stereotactic atlas of the human brain. Stuttgart: Thieme Verlag; 1988.

    Google Scholar 

  16. Kahane P, Tassi L, Francione S. Electroclinical manifestations elicited by intracerebral electric stimulation “shocks” in temporal lobe epilepsy. Neurophysiol Clin. 1993;23:305–26.

    Article  CAS  PubMed  Google Scholar 

  17. Ostrowsky K, Magnin M, Ryvlin P. Representation of pain and somatic sensation in the human insula: a study of responses to direct electrical cortical stimulation. Cereb Cortex. 2002;12:376–85.

    Article  PubMed  Google Scholar 

  18. French JA, Williamson PD, Thadani VM. Characteristics of medial temporal lobe epilepsy, I: results of history and physical examination. Ann Neurol. 1993;34:774–80.

    Article  CAS  PubMed  Google Scholar 

  19. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981;22:489–501.

    Article  Google Scholar 

  20. Mauguière F, Courjon J. Somatosensory epilepsy: a review of 127 cases. Brain. 1978;101:307–32.

    Article  PubMed  Google Scholar 

  21. Salanova V, Andermann F, Rasmussen T. Parietal lobe epilepsy: clinical manifestations and outcome in 82 patients treated surgically between 1929 and 1988. Brain. 1995;118:607–27.

    Article  PubMed  Google Scholar 

  22. Blume WT, Jones DC, Young GB. Seizures involving secondary sensory and related areas. Brain. 1992;115:1509–20.

    Article  PubMed  Google Scholar 

  23. Picard F, Baulac S, Kahane P. Dominant partial epilepsies: a clinical, electrophysiological and genetic study of 19 European families. Brain. 2000;123:1247–62.

    Article  PubMed  Google Scholar 

  24. Bartolomei F, Wendling F, Vignal JP. Neural networks underlying epileptic humming. Epilepsia. 2002;43:1001–12.

    Article  PubMed  Google Scholar 

  25. Ostrowsky K, Isnard J, Ryvlin P. Functional mapping of the insular cortex: clinical implication in temporal lobe epilepsy. Epilepsia. 2000;41(6):681.

    Article  CAS  PubMed  Google Scholar 

  26. Augustine JR. The insular lobe in primates including humans. Neurol Res. 1985;7:2–10.

    Article  CAS  PubMed  Google Scholar 

  27. Augustine JR. Circuitry and functional aspects of the insular lobe in primates including humans. Brain Res Rev. 1996;22:229–44.

    Article  CAS  PubMed  Google Scholar 

  28. Cereda C, Ghika J, Maeder P. Strokes restricted to the insular cortex. Neurology. 2002;59:1950–5.

    Article  CAS  PubMed  Google Scholar 

  29. Robinson CJ, Burton H. Organization of somatosensory receptive fields in cortical areas 7b, retroinsula, postauditory and granular insula of M. fascicularis. J Comp Neurol. 1980;192:69–92.

    Article  CAS  PubMed  Google Scholar 

  30. Schneider RJ, Friedman DP, Mishkin M. A modality-specific somatosensory area within the insula of the rhesus monkey. Brain Res. 1993;621:116–20.

    Article  CAS  PubMed  Google Scholar 

  31. Burton H, Videen TO, Raichle ME. Tactile-vibration-activated foci in insular and parietal-opercular cortex studied with positron emission tomography: mapping the second somatosensory area in humans. Somatosens Mot Res. 1993;10:297–308.

    Article  CAS  PubMed  Google Scholar 

  32. Bornhovd K, Quante M, Glauche V. Painful stimuli evoke different stimulus-response functions in the amygdala, prefrontal, insula and somatosensory cortex: a single-trial fMRI study. Brain. 2002;125:1326–36.

    Article  CAS  PubMed  Google Scholar 

  33. Frot M, Mauguiere F. Dual representation of pain in the operculo-insular cortex in humans. Brain. 2003;126:438–50.

    Article  PubMed  Google Scholar 

  34. Aziz Q, Furlong PL, Barlow J. Topographic mapping of cortical potentials evoked by distention of the human proximal and distal esophagus. Electroencephalogr Clin Neurophysiol. 1995;96:219–28.

    Article  CAS  PubMed  Google Scholar 

  35. Daniels SK, Foundas AL. The role of the insular cortex in dysphagia. Dysphagia. 1997;12:146–56.

    Article  CAS  PubMed  Google Scholar 

  36. Krolak-Salmon P, Henaff MA, Isnard J. An attention modulated response to disgust in human ventral anterior insula. Ann Neurol. 2003;53:446–53.

    Article  PubMed  Google Scholar 

  37. Carmant L, Carrazana E, Kramer U. Pharyngeal dysesthesia as an aura in temporal lobe epilepsy. Epilepsia. 1996;37:911–3.

    Article  CAS  PubMed  Google Scholar 

  38. Garganis K, Papadimitriou C, Gymnopoulos K. Pharyngeal dysesthesias as an aura in temporal lobe epilepsy associated with amygdalar pathology. Epilepsia. 2001;42:565–71.

    Article  CAS  PubMed  Google Scholar 

  39. Ferro JM, Martins IP, Pinto F. Aphasia following right striato-insular infarction in a left-handed child: a clinico-radiological study. Dev Med Child Neurol. 1982;24:173–82.

    Article  CAS  PubMed  Google Scholar 

  40. Habib M, Daquin G, Milandre L. Mutism and auditory agnosia due to bilateral insular damage: role of the insula in human communication. Neuropsychologia. 1995;33:327–39.

    Article  CAS  PubMed  Google Scholar 

  41. Duffau H, Bauchet L, Lehericy S. Functional compensation of the left dominant insula for language. Neuroreport. 2001;12:2159–63.

    Article  CAS  PubMed  Google Scholar 

  42. Munari C, Talairach J, Bonnis A. Differential diagnosis between temporal and perisylvian epilepsy in a surgical perspective. Acta Neurochir. 1980;30:S97–100.

    Article  Google Scholar 

  43. Bossi L, Munari C, Stoffels C. Somatomotor manifestations in temporal lobe seizures. Epilepsia. 1984;25:70–6.

    Article  CAS  PubMed  Google Scholar 

  44. Babkin BP, Van Buren JM. Mechanism and cortical representation of the feeding pattern. Arch Neurol Psychiatr. 1950;66:1–19.

    Article  Google Scholar 

  45. Hauser-Hauw C, Banncaud J. Gustatory hallucinations in epileptic seizures. Brain. 1987;101:339–59.

    Article  Google Scholar 

  46. Cascino GD, Karnes WE. Gustatory and second sensory seizures associated with lesions in the insular cortex seen on magnetic resonance imaging. J Epilepsy. 1990;3:185–7.

    Article  Google Scholar 

  47. Smith-Swintosky VL, Plata-Salaman CR, Scott TR. Gustatory neural coding in the monkey cortex: stimulus quality. J Neurophysiol. 1991;66:1156–65.

    Article  CAS  PubMed  Google Scholar 

  48. Fiol ME, Leppik IE, Mireles R. Ictus emeticus and the insular cortex. Epilepsy Res. 1988;2:127–31.

    Article  CAS  PubMed  Google Scholar 

  49. Kahane P, Hoffmann D, Minotti L. Reappraisal of the human vestibular cortex by cortical electrical stimulation study. Ann Neurol. 2003;54:615–24.

    Article  PubMed  Google Scholar 

  50. Engel J, Williamson PD, Wieser HG. Mesial temporal lobe epilepsies. In: Engel J, Pedley TA, editors. Epilepsy. Philadelphia: Lippincott-Raven; 1997. p. 2417–26.

    Google Scholar 

  51. Wieser HG. Electroclinical features of the psychomotor seizure. Stuttgart: Gustav Fisher; 1983.

    Google Scholar 

  52. Doyle WK, Spencer DD. Anterior temporal resections. In: Engel J, Pedley TA, editors. Epilepsy. Philadelphia: Lippincott-Raven; 1997. p. 1807–17.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India

    Manish Jaiswal M.S., M.Ch.

Authors
  1. Manish Jaiswal M.S., M.Ch.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manish Jaiswal M.S., M.Ch. .

Editor information

Editors and Affiliations

  1. Adnan Menderes University, School of Medicine , Aydın, Turkey

    Mehmet Turgut

  2. Ege University, Department of Anatomy, Izmir, Turkey

    Canan Yurttaş

  3. Seattle Science Foundation, Seattle, Washington, USA

    R. Shane Tubbs

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jaiswal, M. (2018). Insular Cortex Epilepsy. In: Turgut, M., Yurttaş , C., Tubbs, R. (eds) Island of Reil (Insula) in the Human Brain. Springer, Cham. https://doi.org/10.1007/978-3-319-75468-0_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-75468-0_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-75467-3

  • Online ISBN: 978-3-319-75468-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation