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Insular Involvement in Cases of Epilepsy Surgery Failure

Authors :
Jimmy Li
Sandra Reiter-Campeau
Dina Namiranian
Dènahin Hinnoutondji Toffa
Alain Bouthillier
François Dubeau
Dang Khoa Nguyen
Source :
Brain Sciences, Vol 12, Iss 2, p 125 (2022)
Publication Year :
2022
Publisher :
MDPI AG, 2022.

Abstract

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.

Details

Language :
English
ISSN :
12020125 and 20763425
Volume :
12
Issue :
2
Database :
Directory of Open Access Journals
Journal :
Brain Sciences
Publication Type :
Academic Journal
Accession number :
edsdoj.1e49fb4cee46d9818b1a97f8e97afb
Document Type :
article
Full Text :
https://doi.org/10.3390/brainsci12020125