ObjectiveTo evaluate the role of several examinations in the presurgical localization of insular/peri-insular cortex epilepsy (IPICE). MethodsThe 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. Results18 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. ConclusionThe 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.
ObjectiveTo analyse the seizure semeiology of MRI negative insular epilepsy.MethodsA case of patient with insular epilepsy who presented in Epileptic Center, Guangdong 999 Brain Hospital was collected. Related literatures were thoroughly reviewed.ResultsThe patient was diagnosised as insular epilepsy by SEEG and postoperative pathology reported focal cortical dysplasia Ib.ConclusionsThe insula lobe is a part of the limbic system, and the seizure semeiology in insular epilepsy is varied. Seizure semeiology analysis is particularly important in the evaluation of presurgical especially in a MRI negative case. In this paper, we summarized the semeiology characteristics of various parts of insula lobe, and provided some references for the diagnosis and treatment of insular epilepsy.
ObjectiveTo investigate the efficacy and safety of Stereotactic electroencephalogram (SEEG)-guided Radiofrequency-thermocoagulation (RF-TC) in the treatment of refractory insular epilepsy in children.MethodsThe clinical data of 7 children with SEEG-confirmed insular epilepsy admitted to the Epilepsy Center of the Children’s Hospital Affiliated to Shandong University from January 2021 to May 2022, were retrospectively analyzed (3 males and 4 females; average age, 6.6±3.5 years). All patients underwent stage I pre-operative evaluation, and were implanted with SEEG electrodes for video EEG monitoring. The radiofrequency thermocoagulation contacts were determined according to SEEG and imaging results, and radiofrequency thermocoagulation was performed via electrode contacts. The patients were followed up at 3, 6, 12 and 18 months after operation by outpatient review or via telephone interview. The clinical efficacy was evaluated by Engel classification and complications were recorded. ResultsSix cases (6/7) were characterized by nocturnal seizures, and four cases (4/7) exhibited hypermotor or complex motor seizures. Three cases (3/7) showed focal ankylosis; only 1 patient had aura. All of the 7 cases showed interictal scalp EEG consistent with the side of surgery: 6 cases showed distribution in the perilateral fissure region, and 1 case showed confinement to the temporal region. In MRI, 4 cases showed negative signal, 2 cases showed unclear gray-white matter boundary, and 1 case showed thickening of the insular cortex. All of the 7 patients received electrode implantation and completed follow-up for over 6 months [6.0~22.0 (12.3±5.3) months]. At the last follow-up, 5 of the 7 children were seizure free (Engel class la), and 2 still had seizures after surgery, with no postoperative long-term complications.ConclusionChildren with insular epilepsy rarely show an aura, but have prominent motor symptoms, and the scalp electroencephalogram is mainly distributed in the perilateral fissured area. SEEG-guided RF-TC has good safety and efficacy in the treatment of drug‐resistant insular epilepsy.