Multimodal investigation of epileptic networks

Zerouali, Younes; Ghaziri, Jimmy; Nguyen, Dang Khoa

doi:10.1016/bs.pbr.2016.04.004

Cited by 9 publications

(11 citation statements)

References 164 publications

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“…Insular epilepsy (IE) is a rare form of drug‐resistant epilepsy (DRE), comprising under 3% of cases investigated at tertiary epilepsy centers 1 . However, recognition of IE as a significant cause of DRE has increased since its contemporary definition in 2004 2–4 . Increased safety of both open 5–8 and stereotactic electroencephalography (SEEG) electrode placement in the insula and peri‐Sylvian region 2,7,9–20 has led to increased detection of IE in many centers around the world 2,6,11,16,21–32 .…”

Section: Introductionmentioning

confidence: 99%

“…1 However, recognition of IE as a significant cause of DRE has increased since its contemporary definition in 2004. [2][3][4] Increased safety of both open [5][6][7][8] and stereotactic electroencephalography (SEEG) electrode placement in the insula and peri-Sylvian region 2,7,[9][10][11][12][13][14][15][16][17][18][19][20] has led to increased detection of IE in many centers around the world. 2,6,11,16,[21][22][23][24][25][26][27][28][29][30][31][32] Over the last 15 years, several institutions have reported their experience with resective surgery for IE.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

et al. 2022

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Insular epilepsy (IE) is an increasingly recognized cause of drug-resistant epilepsy amenable to surgery. However, concerns of suboptimal seizure control and permanent neurological morbidity hamper widespread adoption of surgery for IE.We performed a systematic review and individual participant data meta-analysis to determine the efficacy and safety profile of surgery for IE and identify predictors of outcomes. Of 2483 unique citations, 24 retrospective studies reporting on 312 participants were eligible for inclusion. The median follow-up duration was 2.58 years (range, 0-17 years), and 206 (66.7%) patients were seizure-free at last follow-up. Younger age at surgery

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

et al. 2022

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“…Comparing patients with OIE and TLE also disclosed an FDR-corrected increase in CS between the ipsilateral dorsal granular and agranular subregions. In this sense, the epileptic network of OIE was previously shown to involve subregions of the insula and regions heavily connected to the insula such as the mid to anterior cingulate gyrus [14,58,59]. It could be argued that propagation of epileptic dis-charges originating from the mesiotemporal structures may include insular subregions and result in connectivity alterations within the insular network of patients with TLE.…”

Section: Discussionmentioning

confidence: 99%

Structural Connectivity Alterations in Operculo-Insular Epilepsy

et al. 2021

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Operculo-insular epilepsy (OIE) is an under-recognized condition that can mimic temporal and extratemporal epilepsies. Previous studies have revealed structural connectivity changes in the epileptic network of focal epilepsy. However, most reports use the debated streamline-count to quantify ‘connectivity strength’ and rely on standard tracking algorithms. We propose a sophisticated cutting-edge method that is robust to crossing fibers, optimizes cortical coverage, and assigns an accurate microstructure-reflecting quantitative conectivity marker, namely the COMMIT (Convex Optimization Modeling for Microstructure Informed Tractography)-weight. Using our pipeline, we report the connectivity alterations in OIE. COMMIT-weighted matrices were created in all participants (nine patients with OIE, eight patients with temporal lobe epilepsy (TLE), and 22 healthy controls (HC)). In the OIE group, widespread increases in ‘connectivity strength’ were observed bilaterally. In OIE patients, ‘hyperconnections’ were observed between the insula and the pregenual cingulate gyrus (OIE group vs. HC group) and between insular subregions (OIE vs. TLE). Graph theoretic analyses revealed higher connectivity within insular subregions of OIE patients (OIE vs. TLE). We reveal, for the first time, the structural connectivity distribution in OIE. The observed pattern of connectivity in OIE likely reflects a diffuse epileptic network incorporating insular-connected regions and may represent a structural signature and diagnostic biomarker.

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“…11 Their sensitivity is indeed low (17%) as well as the specificity (53%). 33 Nevertheless, hypometabolism of the right posterior insula in 18 F-FDG-PET has been detected in several cases of insular epilepsy related with ictal asystole. 34 No other PET tracer has been tested for the diagnosis of insular epilepsy.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

Diagnostic and therapeutic approaches in refractory insular epilepsy

et al. 2023

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Due to heterogenous seizure semiology and poor contribution of scalp electroencephalography (EEG) signals, insular epilepsy requires use of the appropriate diagnostic tools for its diagnosis and characterization. The deep location of the insula also presents surgical challenges. The aim of this article is to review the current diagnostic and therapeutic tools and their contribution to the management of insular epilepsy. Magnetic resonance imaging (MRI), isotopic imaging, neurophysiological imaging, and genetic testing should be used and interpretated with caution. Isotopic imaging and scalp EEG have demonstrated a lower value in epilepsy from insular compared to temporal origin, which increases the interest of functional MRI and magnetoencephalography. Intracranial recording with stereoelectroencephalography (SEEG) is often required. The insular cortex, being highly connected and deeply located under highly functional areas, is difficult to reach, and its ablative surgery raises functional issues. Tailored resection based on SEEG or alternative curative treatments, such as radiofrequency thermocoagulation, laser interstitial thermal therapy, or stereotactic radiosurgery, have produced encouraging results. The management of insular epilepsy has benefited from major advances in the last years. Perspectives for diagnostic and therapeutic procedures will contribute to better management of this complex form of epilepsy.

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Multimodal investigation of epileptic networks

Cited by 9 publications

References 164 publications

Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

Structural Connectivity Alterations in Operculo-Insular Epilepsy

Diagnostic and therapeutic approaches in refractory insular epilepsy

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