A study of perfusion changes with Insula Epilepsy using SPECT

Sala-Padró, Jacint; Fong, Michael W.; Rahman, Zebunnessa; Bartley, Melissa; Gill, Deepak; Dexter, Mark; Bleasel, Andrew; Wong, Chong

doi:10.1016/j.seizure.2019.03.021

Cited by 12 publications

(11 citation statements)

References 38 publications

(48 reference statements)

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“…Propagation of insular seizures is typically from inside the insula to extrainsular connections [7]. The contralateral insula engagement could also be very fast in less than 1 s [16]. Here, we found that the posterior insular onset seizures spread both to extrainsular and intrainsular regions, while opercular onset seizures tend to propagate to extrainsular regions.…”

Section: Electrographic Findingsmentioning

confidence: 51%

Bilateral asymmetric tonic seizure in insulo-opercular epilepsy: an anatomo-electro-clinical study

Wang

et al. 2020

Acta Epileptologica

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Background Insulo-opercular seizures are highly heterogeneous in seizure semiology and electrical features. Bilateral asymmetric limb posturing, as a classical pattern of supplementary sensorimotor area (SMA) seizure, also occurs in insulo-opercular epilepsy. This study was aimed to study the anatomo-electro-clinical correlations in bilateral asymmetric tonic seizures (BATS), in order to advance the understanding of insulo-opercular epilepsy. Methods Eight patients with insulo-opercular epilepsy as confirmed by stereoelectroencephalography (SEEG) and manifesting BATS as the major ictal motor sign, in Guangdong Sanjiu Brain Hospital Epilepsy Center from 2014 to 2018, were employed in this study. The BATS of the patients were evaluated, and the semiologic features and concomitant intracerebral EEG changes were quantified. Then the variables were examined with Cluster Analysis, and the semiologic features were correlated with anatomic localization using the Kendall correlation test. Results Of the 8 patients, the most frequent initial motor sign was bilateral asymmetric tonic posturing (62.5%). Facial tonic-clonic sign also had a high prevalence in the evolution of seizures (87.5%). The results of Cluster Analysis showed that the semiologic features were subdivided into two main groups, one group comprising exclusively BATS and the other including signs of focal tonic seizure, aura, focal limb tonic-clonic seizure (TCS), facial TCS, hypermotor behavior, eye movement, autonomic changes and generalized TCS. The BATS was strongly associated with the posterior long gyrus (PLG) of insula (t = 0.732) and parietal operculum (t = 1.000); the hypermotor behaviors were associated with the anterior long gyrus (ALG) (t = 0.770); and the autonomic changes were associated with the anterior limiting sulcus (ALS) (t = 0.734) and middle short gyrus (MSG) (t = 0.700). Conclusions The seizure semiology of insulo-opercular epilepsy is characterized, in temporal order, by BATS, with or without simultaneous hypermotor behaviors, and frequently ends up with facial tonic-clonic signs, which is different from that of the SMA seizure. The early spread network involving the posterior insular lobe and parietal operculum may contribute to this pattern of manifestation.

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Section: Electrographic Findingsmentioning

confidence: 51%

Bilateral asymmetric tonic seizure in insulo-opercular epilepsy: an anatomo-electro-clinical study

Wang

et al. 2020

Acta Epileptologica

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“…In this series, only two patients had insular abnormalities on MRI. SPECT is thought to be of moderate value in identifying insular epilepsy [ 20 , 21 ]. Similarly, PET has been thought to generate inconsistent findings, though some recent studies may suggest otherwise [ 20 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Insular Involvement in Cases of Epilepsy Surgery Failure

Reiter-Campeau

Namiranian

et al. 2022

Brain Sciences

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Background: Epilepsy surgery failure is not uncommon, with several explanations having been proposed. In this series, we detail cases of epilepsy surgery failure subsequently attributed to insular involvement. Methods: We retrospectively identified patients investigated at the epilepsy monitoring units of two Canadian tertiary care centers (2004–2020). Included patients were adults who had undergone epilepsy surgeries with recurrence of seizures post-operatively and who were subsequently determined to have an insular epileptogenic focus. Clinical, electrophysiological, neuroimaging, and surgical data were synthesized. Results: We present 14 patients who demonstrated insular epileptic activity post-surgery-failure as detected by intracranial EEG, MEG, or seizure improvement after insular resection. Seven patients had manifestations evoking possible insular involvement prior to their first surgery. Most patients (8/14) had initial surgeries targeting the temporal lobe. Seizure recurrence ranged from the immediate post-operative period to one year. The main modality used to determine insular involvement was MEG (8/14). Nine patients underwent re-operations that included insular resection; seven achieved a favorable post-operative outcome (Engel I or II). Conclusions: Our series suggests that lowering the threshold for suspecting insular epilepsy may be necessary to improve epilepsy surgery outcomes. Detecting insular epilepsy post-surgery-failure may allow for re-operations which may lead to good outcomes.

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“…We also found that focal seizures involving a CdG sign in the semiology does not always localize the SOZ to the frontal lobe. Finally, because of its depth relative to other regions of the brain, the insula cannot be reliably delineated by scalp EEG recordings [14]. Here, SEEG recorded electrographic seizure onset from contacts implanted into the anterior insula prior to involvement of the frontal lobe when the clinical semiology involving the CdG sign became evident.…”

Section: Discussionmentioning

confidence: 99%

Focal seizures associated with the chapeau de gendarme sign or ictal pouting of insular origin

Wiwchar

Hader

Pauranik

et al. 2019

Epilepsy & Behavior Reports

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We report a teenager with childhood onset focal seizures associated with the chapeau de gendarme sign or ictal pouting of anterior insular lobe origin. The chapeau de gendarme sign has been associated with frontal lobe seizures in patients with focal epilepsy. However, in this case, stereo-electroencephalography (SEEG) localized seizures to the anterior insular cortex prior to her typical clinical manifestations. Surgical resection of the insular and frontal-lobe network resulted in seizure freedom. We propose that the anterior insular cortex should be a site of investigation during pre-surgical phase 2 evaluation in patients exhibiting the chapeau de gendarme sign during focal seizures.

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A study of perfusion changes with Insula Epilepsy using SPECT

Cited by 12 publications

References 38 publications

Bilateral asymmetric tonic seizure in insulo-opercular epilepsy: an anatomo-electro-clinical study

Bilateral asymmetric tonic seizure in insulo-opercular epilepsy: an anatomo-electro-clinical study

Insular Involvement in Cases of Epilepsy Surgery Failure

Focal seizures associated with the chapeau de gendarme sign or ictal pouting of insular origin

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