The role of the insular cortex in temporal lobe epilepsy

Annals of NeurologyVolume 48, Issue 4 p. 614-623 Original Article The role of the insular cortex in temporal lobe epilepsy Jean Isnard MD, Jean Isnard MD Functional Neurology and Epileptology Department, Neurological Hospital, Lyon, FranceSearch for more papers by this authorMarc Guénot MD, Marc Guénot MD Neurosurgery Department, Neurological Hospital, Lyon, FranceSearch for more papers by this authorKarine Ostrowsky MD, Karine Ostrowsky MD Functional Neurology and Epileptology Department, Neurological Hospital, Lyon, FranceSearch for more papers by this authorMarc Sindou MD, PhD, Marc Sindou MD, PhD Neurosurgery Department, Neurological Hospital, Lyon, FranceSearch for more papers by this authorFrançois Mauguière MD, PhD, Corresponding Author François Mauguière MD, PhD Functional Neurology and Epileptology Department, Neurological Hospital, Lyon, FranceFunctional Neurology and Epileptology Department, Neurological Hospital, 59 Boulevard Pinel, 69003 Lyon, FranceSearch for more papers by this author Jean Isnard MD, Jean Isnard MD Functional Neurology and Epileptology Department, Neurological Hospital, Lyon, FranceSearch for more papers by this authorMarc Guénot MD, Marc Guénot MD Neurosurgery Department, Neurological Hospital, Lyon, FranceSearch for more papers by this authorKarine Ostrowsky MD, Karine Ostrowsky MD Functional Neurology and Epileptology Department, Neurological Hospital, Lyon, FranceSearch for more papers by this authorMarc Sindou MD, PhD, Marc Sindou MD, PhD Neurosurgery Department, Neurological Hospital, Lyon, FranceSearch for more papers by this authorFrançois Mauguière MD, PhD, Corresponding Author François Mauguière MD, PhD Functional Neurology and Epileptology Department, Neurological Hospital, Lyon, FranceFunctional Neurology and Epileptology Department, Neurological Hospital, 59 Boulevard Pinel, 69003 Lyon, FranceSearch for more papers by this author First published: 13 April 2001 https://doi.org/10.1002/1531-8249(200010)48:4<614::AID-ANA8>3.0.CO;2-SCitations: 263AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract The role of the insular cortex in the genesis of temporal lobe epileptic (TLE) seizures has been investigated in 21 patients with drug-refractory TLE using chronic depth stereotactic recordings of the insular cortex activity and video recordings of ictal symptoms during 81 spontaneous electroclinical seizures. All of the recorded seizures were found to invade the insula, most often after a relay in the ipsilateral hippocampus (19/21 patients). However, 2 patients had seizures that originated in the insular cortex itself. Ictal symptoms associated with the insular discharges were similar to those usually attributed to mesial temporal lobe seizures, so that scalp video-electroencephalographic monitoring does not permit making any difference between ictal symptoms of temporo-mesial and insular discharges. A favorable outcome was obtained after a temporal cortectomy sparing the insular cortex in 15 of 17 operated patients. Seizures propagating to the insular cortex were found to be fully controlled by surgery, whereas those originating in the insular cortex persisted after temporal cortectomy. The fact that seizures originating in the insular cortex are not influenced by temporal lobectomy is likely to explain some of the failures of this surgical procedure in TLE. Ann Neurol 2000;48:614–623 Citing Literature Volume48, Issue4October 2000Pages 614-623 RelatedInformation