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Mapping the Insula with Stereo-Electroencephalography: The Emergence of Semiology in Insula Lobe Seizures
- Source :
- Annals of Neurology, Annals of Neurology, 2020, 88 (3), pp.477-488. ⟨10.1002/ana.25817⟩
- Publication Year :
- 2020
-
Abstract
- OBJECTIVE Insula epilepsy is rare and can be evaluated effectively by Stereotactic intracerebral EEG (SEEG). Many previous studies of insulo-opercular seizures have been unable to separate insular and opercular onset. With adequate sampling of the insula, this study shows this is possible. METHODS We analyzed intrainsular dynamics and extrainsular propagation in 12 patients with "pure" insula epilepsy (n = 9) or insular and only deepest opercular involvement (n = 3) at seizure onset. Review of semiology defined clinical groups, agglomerative cluster, and principal component analysis of semiological features were performed. Quantitative epileptogenicity, and intrainsular and extrainsular propagation were computed via time frequency analysis and epileptogenicity mapping. RESULTS Seizure onset patterns were heterogeneous; the seizure onset zone was focal. Seizure onset and first ictal change within insula functional subdivision correlated with aura and reflex component. No paninsular spread occurred; contralateral insular spread was very early. While the discharge was intrainsular, clinical signs related to aura or vegetative signs. Extrainsular propagation was early and related to the emergence of the majority of clinical signs. Cluster analysis found an anterior, intermediate, and posterior insula seizure onset group. The largest principal component separated anterior insula manifestations, including early hypermotor signs, early recovery, and no aura from posterior insula features of early dystonia, early tonic motor features, and sensorimotor aura. INTERPRETATION Aura is vital to identifying seizure onset and relates to insula functional subdivision. Seizures are heterogenous; extrainsular propagation occurs early, accounting for most of the semiology. With adequate sampling, "pure" insula epilepsy can be identified and focal curative resection is possible. ANN NEUROL 2020;88:477-488.
- Subjects :
- 0301 basic medicine
Adult
Male
medicine.medical_specialty
Adolescent
Aura
[SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology
Electroencephalography
Audiology
behavioral disciplines and activities
Stereoelectroencephalography
Stereotaxic Techniques
03 medical and health sciences
Epilepsy
Young Adult
0302 clinical medicine
Seizures
medicine
Humans
Ictal
Child
ComputingMilieux_MISCELLANEOUS
Dystonia
Cerebral Cortex
Brain Mapping
medicine.diagnostic_test
business.industry
Semiology
Middle Aged
medicine.disease
030104 developmental biology
nervous system
Neurology
Female
Neurology (clinical)
Electrocorticography
business
Insula
psychological phenomena and processes
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15318249 and 03645134
- Volume :
- 88
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Annals of neurologyReferences
- Accession number :
- edsair.doi.dedup.....fc31acddec399aca7358c875e63cf51f