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Chapter 17 - Invasive Investigation of Insular Epilepsy: Indications and Preplanning

from Section 4 - Invasive Investigation of Insular Epilepsy

Published online by Cambridge University Press:  09 June 2022

By
Philippe Ryvlin  and
Fabienne Picard
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

Invasive EEG investigation of the insular cortex has been performed with increasing frequency since the mid-nineties, in various forms of focal drug-resistant epilepsies. These include patients with a clear-cut intra-insular epileptogenic lesion, such as a focal cortical dysplasia, as well as patients whose non-invasive pre-surgical evaluation suggests perisylvian epilepsy, temporal plus epilepsy, sleep hypermotor epilepsy, MRI-negative frontal, and parietal lobe epilepsies. SEEG 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. Intra-insular ictal EEG patterns 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. SEEG also 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.

Keywords

insulaSEEGhypermotor seizureperisylvianthermolesion
Type
Chapter
Information
Insular Epilepsies , pp. 203 - 210
Publisher: Cambridge University Press
Print publication year: 2022

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