A clinical study on the presurgical localization of the epileptogenic zones for patients with insular/peri-insular cortex epilepsy_Journal of Epilepsy

Authors：

 YUTao ¹ , ZHOUChangshuai ¹ , NIDuanyu ¹ , QIAOLiang ¹ , WANGXueyuan ¹ , ZHANGXiating ² , ZHANGGuojun ¹ , WANGYuping ² ,  LIYongjie ¹

1. Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
2. Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;

Corresponding author：

LIYongjie, Email: lyj8828@vip.sina.com

Keywords：

Insular; Epilepsy; Localization; Magnetoencephalography; Surgery

DOI：

10.7507/2096-0247.20160054

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Objective To evaluate the role of several examinations in the presurgical localization of insular/peri-insular cortex epilepsy (IPICE). Methods The data of patients with IPICE who were identified by resective surgery from 2011.1 to 2015.4 were retrospectively analyzed. The role of semiology, scalp EEG, MRI and magnetoencephalography (MEG)in the localization of epileptogenic zones for patients with IPICE were evaluated. Results 18 patients were selected according to the criteria. The localization of IPICE was supported by semiology in 16 patients, supported by MRI in 6 patients, supported by MEG in 17 patients. In 12 patients with negative MRI, the dipoles were showed in insular/peri-insular area in 11 patients. The localization role of MEG for patients with IPICE is more obvious than that of MRI (P < 0.05). The MEG result played conclusive role in 9 patients. According to result of MEG, the plans of intracranial recording were canceled in 3 patients, and the plans of intracranial electrodes implanting were modified in 5 patients. The resective surgery involving the insular/peri-insular cortex was performed in all the 18 patients. During the follow-up of 12~48 months, seizure-free was reported in 11 patients, although 2 patients were missed. Conclusion The combination of the results of semiology, scalp EEG, MRI and MEG was helpful in the localization of epileptogenic zones for patients with IPICE, and MEG played a valuable role in this localization.

Citation： YUTao, ZHOUChangshuai, NIDuanyu, QIAOLiang, WANGXueyuan, ZHANGXiating, ZHANGGuojun, WANGYuping, LIYongjie. A clinical study on the presurgical localization of the epileptogenic zones for patients with insular/peri-insular cortex epilepsy. Journal of Epilepsy, 2016, 2(4): 308-311. doi: 10.7507/2096-0247.20160054 Copy

1.	Isnard J, Guenot M, Ostrowsky K, et al. The role of the insular cortex in temporal lobe epilepsy. Ann Neurol, 2000, 48(4):614-623.
2.	Mohamed IS, Gibbs S A, Robert M, et al. The utility of magnetoencephalography in the presurgical evaluation of refractory insular epilepsy. Epilepsia, 2013, 54(11):1950-1959.
3.	Chevrier MC, Bard C, Guilbert F, et al. Structural abnormalities in patients with insular/peri-insular epilepsy:spectrum, frequency, and pharmacoresistance. AJNR Am J Neuroradiol, 2013, 34(11):2152-2156.
4.	Pugnaghi M, Meletti S, Castana L, et al. Features of somatosensory manifestations induced by intracranial electrical stimulations of the human insula. Clin Neurophysiol, 2011, 122(10):2049-2058.
5.	Guenot M, Isnard J, Sindou M. Surgical anatomy of the insula. Advances and technical standards in neurosurgery, 2004, 29(5):265.
6.	Ostrowsky K, Isnard J, Ryvlin P, et al. Functional mapping of the insular cortex:clinical implication in temporal lobe epilepsy. Epilepsia, 2000, 41(6):681-686.
7.	Isnard J, Guenot M, Sindou M, et al. Clinical manifestations of insular lobe seizures:a stereo-electroencephalographic study. Epilepsia, 2004, 45(9):1079-1090.
8.	Mazzola L, Isnard J, Mauguiere F. Somatosensory and pain responses to stimulation of the second somatosensory area (SⅡ) in humans. A comparison with SI and insular responses. Cereb Cortex, 2006, 16(7):960-968.
9.	Afif A, Minotti L, Kahane P, et al. Anatomofunctional organization of the insular cortex:a study using intracerebral electrical stimulation in epileptic patients. Epilepsia, 2010, 51(11):2305-2315.
10.	Pugnaghi M, Meletti S, Castana L, et al. Features of somatosensory manifestations induced by intracranial electrical stimulations of the human insula. Clin Neurophysiol, 2011, 122(10):2049-2058.
11.	Mazzola L, Lopez C, Faillenot I, et al. Vestibular responses to direct stimulation of the human insular cortex. Ann Neurol, 2014, 76(4):609-619.
12.	Nguyen DK, Nguyen DB, Malak R, et al. Revisiting the role of the insula in refractory partial epilepsy. Epilepsia, 2009, 50(3):510-520.
13.	Landtblom AM, Lindehammar H, Karlsson H, et al. Insular cortex activation in a patient with "sensed presence"/ecstatic seizures. Epilepsy Behav, 2011, 20(4):714-718.

1. Isnard J, Guenot M, Ostrowsky K, et al. The role of the insular cortex in temporal lobe epilepsy. Ann Neurol, 2000, 48(4):614-623.
2. Mohamed IS, Gibbs S A, Robert M, et al. The utility of magnetoencephalography in the presurgical evaluation of refractory insular epilepsy. Epilepsia, 2013, 54(11):1950-1959.
3. Chevrier MC, Bard C, Guilbert F, et al. Structural abnormalities in patients with insular/peri-insular epilepsy:spectrum, frequency, and pharmacoresistance. AJNR Am J Neuroradiol, 2013, 34(11):2152-2156.
4. Pugnaghi M, Meletti S, Castana L, et al. Features of somatosensory manifestations induced by intracranial electrical stimulations of the human insula. Clin Neurophysiol, 2011, 122(10):2049-2058.
5. Guenot M, Isnard J, Sindou M. Surgical anatomy of the insula. Advances and technical standards in neurosurgery, 2004, 29(5):265.
6. Ostrowsky K, Isnard J, Ryvlin P, et al. Functional mapping of the insular cortex:clinical implication in temporal lobe epilepsy. Epilepsia, 2000, 41(6):681-686.
7. Isnard J, Guenot M, Sindou M, et al. Clinical manifestations of insular lobe seizures:a stereo-electroencephalographic study. Epilepsia, 2004, 45(9):1079-1090.
8. Mazzola L, Isnard J, Mauguiere F. Somatosensory and pain responses to stimulation of the second somatosensory area (SⅡ) in humans. A comparison with SI and insular responses. Cereb Cortex, 2006, 16(7):960-968.
9. Afif A, Minotti L, Kahane P, et al. Anatomofunctional organization of the insular cortex:a study using intracerebral electrical stimulation in epileptic patients. Epilepsia, 2010, 51(11):2305-2315.
10. Pugnaghi M, Meletti S, Castana L, et al. Features of somatosensory manifestations induced by intracranial electrical stimulations of the human insula. Clin Neurophysiol, 2011, 122(10):2049-2058.
11. Mazzola L, Lopez C, Faillenot I, et al. Vestibular responses to direct stimulation of the human insular cortex. Ann Neurol, 2014, 76(4):609-619.
12. Nguyen DK, Nguyen DB, Malak R, et al. Revisiting the role of the insula in refractory partial epilepsy. Epilepsia, 2009, 50(3):510-520.
13. Landtblom AM, Lindehammar H, Karlsson H, et al. Insular cortex activation in a patient with "sensed presence"/ecstatic seizures. Epilepsy Behav, 2011, 20(4):714-718.

Journal of Epilepsy

A clinical study on the presurgical localization of the epileptogenic zones for patients with insular/peri-insular cortex epilepsy

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