Successful surgical treatment of insular epilepsy with nocturnal hypermotor seizures

Dobesberger, Judith; Ortler, Martin; Unterberger, Iris; Walser, Gerald; Falkenstetter, Tina; Bodner, Thomas; Benke, Thomas; Bale, Reto; Fiegele, T.; Donnemiller, Eveline; Gotwald, Thaddaeus; Trinka, Eugen

doi:10.1111/j.1528-1167.2007.01426.x

Cited by 80 publications

(46 citation statements)

References 13 publications

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“…data]. Unlike past studies, 28 more recent publications suggest that insular epilepsy surgery can be both safe and beneficial when performed with modern microsurgical techniques [8,29,30,31,32,33,34]. Still, surgery in the insular region remains a challenge because of the risk of injury to the surrounding highly functional opercula, the numerous arteries transiting on the surface of the insula, and deeper structures (such as the arcuate fasciculus, basal ganglia and internal capsule) [35,36].…”

Section: Discussionmentioning

confidence: 99%

Gamma Knife Surgery for Refractory Insular Cortex Epilepsy

Irislimane

Mathieu

Bouthillier

et al. 2013

Stereotact Funct Neurosurg

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Background: Resection of the epileptogenic insular cortex is surgically challenging. We sought to evaluate the potential of Gamma Knife® surgery (GKS) for the treatment of pharmacoresistant insular cortex epilepsy (ICE) in patients who underwent GKS between 2005 and 2010. Adverse events and effects on seizure frequency were assessed. Methods: Three cases of refractory ICE were treated by GKS between 2005 and 2010. Results: Case 1 had refractory nonlesional ICE, proven by depth electrodes only partially helped by a left posterior insulectomy. Case 2 had refractory ICE due to a left insular cavernoma. Case 3 had refractory ICE, confirmed by an invasive study but complicated by transient dysphasia from contusion of Wernicke's area. The marginal and maximum radiation doses delivered were 20 and 40 Gy, respectively. Treatment volume ranged from 1.2 to 3.2 cm³. Two out of 3 patients experienced significant seizure reduction and the third had a worthwhile improvement (follow-up 30-76 months). Complete antiepileptic drug withdrawal was un-fortunately not possible. Complications included transient lightheadedness and new-onset seizures responsive to medical treatment, both in the same patient. Conclusion: GKS is a promising technique for selected drug-resistant ICE patients. Additional observations are necessary.

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Section: Discussionmentioning

confidence: 99%

Gamma Knife Surgery for Refractory Insular Cortex Epilepsy

Irislimane

Mathieu

Bouthillier

et al. 2013

Stereotact Funct Neurosurg

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“…The preoperative and postoperative MRI show that the remnant insular cortex was completely removed using subpial depth electrodes (c, d) [17]. Also, non-lesional patients with insular seizure onset and nocturnal hypermotor seizure have successfully undergone epilepsy surgery [6].…”

Section: Insular Surgerymentioning

confidence: 99%

Insular epilepsy surgery under neuronavigation guidance using depth electrode

et al. 2009

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Objectives The unfavorable surgical results that have been reported with insular epilepsy surgery may be related to inadequate monitoring. Insular epilepsy surgery requires the precise monitoring and tailored removal of the epileptic zone. The purposes of this study were to precisely monitor the hidden cortex and determine the effectiveness of using different monitoring methods, including subpial depth electrodes. Materials and methods This is a study of a single center series of six patients (three men, three women) who underwent insular surgery between May 2006 and December 2007. All patients had experienced medically intractable seizures without any evidence of a tumorous condition based on previous examination. We used strip electrode implantation in one patient and stereotactic depth electrode insertion in two patients, which resulted in partial removal of the insular. The other three patients underwent open direct subpial depth electrode insertion, which resulted in total removal of the insular cortex. Results There were no surgery-related complications with the insulectomy after insertion of the subpial depth electrodes, regardless of the monitoring method or extent of removal. All patients except for one showed considerable improvement in epilepsy (83.3% Engle class I, 16.5% Engle class II). In the three patients who had open direct subpial depth electrodes inserted, we achieved total insulectomy without increasing the surgical morbidity, while in the other three patients, the insular removal was only partial. Conclusion We demonstrate that image-guided insular surgery with safe and accurate depth electrode guidance results in an optimal outcome and complete resection of the insular cortex.

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“…In recent years it has been shown that sleep-related complex motor attacks, similar to those occurring in NFLE patients, may also originate from the temporal lobe [8,71,72,81], the insular-opercular region [9, 65•, 84••, 85,86], and the posterior cerebral regions [65•]. A careful analysis of aura features may be particularly useful in the differential diagnosis of NFLE.…”

Section: Clinical Features Of Nflementioning

confidence: 99%

Nocturnal Frontal Lobe Epilepsy

Nobili

Proserpio

Combi

et al. 2014

Curr Neurol Neurosci Rep

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Nocturnal frontal lobe epilepsy (NFLE) is a syndrome of heterogeneous etiology, characterized by the occurrence of sleep-related seizures with different complexity and duration. Genetic, lesional, and cryptogenetic NFLE forms have been described. NFLE is generally considered a benign clinical entity, although severe, drug-resistant forms do exist. A significant proportion of sleep-related complex motor seizures, hardly distinguishable from NFLE, originate outside the frontal lobe. Moreover, the distinction of NFLE from the non-rapid eye movement arousal parasomnias may be challenging. A correct diagnosis of NFLE should be based on a diagnostic approach that includes the anamnestic, video-polysomnographic, morphological, and genetic aspects. Studies on the relationships between genes, arousal regulatory mechanisms, and epileptogenesis, using both clinical and experimental models of NFLE might provide key insights in the interrelationship between sleep and epilepsy.

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Successful surgical treatment of insular epilepsy with nocturnal hypermotor seizures

Abstract: SUMMARY

Cited by 80 publications

References 13 publications

Gamma Knife Surgery for Refractory Insular Cortex Epilepsy

Gamma Knife Surgery for Refractory Insular Cortex Epilepsy

Insular epilepsy surgery under neuronavigation guidance using depth electrode

Nocturnal Frontal Lobe Epilepsy

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