Decreased self-reported appetite following insular cortex resection in patients with epilepsy

Hébert-Seropian, Benjamin; Boucher, Olivier; Citherlet, Daphné; Roy-Côté, Frédérique; Gravel, Victoria; Obaid, Sami; Bouthillier, Alain; Nguyen, Dang Khoa

doi:10.1016/j.appet.2021.105479

Cited by 12 publications

(4 citation statements)

References 45 publications

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“…The frontoinsular cortex is defined by the presence of von Economo neurons [4], but the functions of these neurons and this cortical area remain largely unknown. In one study, 7 of 17 epileptic patients reported a persistent change in appetite after resection of the insular cortex, but their body weights did not change, and the effect did not localize to a specific insular subregion [12]. Studies identifying a loss of drug-related urges after ischemic strokes that involved the insula also did not localize the effect to a specific subregion [9, 10], and patients who stopped craving cigarettes did not report a change in appetite [9], raising the possibility that separate regions are relevant to drug- and food-related cravings.…”

Section: Discussionmentioning

confidence: 99%

Sustained, Effortless Weight Loss after Damage to the Left Frontoinsular Cortex: A Case Report

Reasoner

Boes

Geerling³

2023

Case Rep Neurol

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This case report highlights a possible consequence of damage to the left frontoinsular region. A 53-year-old woman with chronic obesity and headaches presented with seizure, leading to the discovery and resection of a large sphenoid wing meningioma. Postoperative brain imaging revealed loss of the left frontoinsular cortex and portions of the underlying white matter, claustrum, and striatum. Throughout her adult life, this patient had tried and failed to lose weight, but after surgery, she no longer desired to eat large meals, and without effort, her body mass index decreased from 38.6 (85th percentile) to 24.9 (25th percentile). Combined with previous research implicating the insular cortex in interoception, appetite, and drug-related urges, her reduced hunger and effortless weight loss after resection of the left frontoinsular cortex suggest that this region of the human brain may play a role in hunger-related urges that contribute to overeating.

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Section: Discussionmentioning

confidence: 99%

Sustained, Effortless Weight Loss after Damage to the Left Frontoinsular Cortex: A Case Report

Reasoner

Boes

Geerling³

2023

Case Rep Neurol

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“…Autonomic function changes are also reported after insular resection, including changes in heart rate variability 78 . Self‐reported decreased appetite is described after insular resection, probably in relation to dysfunctional interoceptive and gustatory functions, which is concordant with implication of the insular cortex in feeding behaviors 79 . Cognitive impairment remains rare after insular resection, 80 even in the case of children with previously impaired development 81 .…”

Section: Therapeutic Approaches To Insular Epilepsymentioning

confidence: 97%

“…78 Self-reported decreased appetite is described after insular resection, probably in relation to dysfunctional interoceptive and gustatory functions, which is concordant with implication of the insular cortex in feeding behaviors. 79 Cognitive impairment remains rare after insular resection, 80 even in the case of children with previously impaired development. 81 Nevertheless, subtle deficits in specific cognitive functions can be expected (e.g., impairment of processes associated with the oro-motor function).…”

Section: Insular Resectionmentioning

confidence: 99%

Diagnostic and therapeutic approaches in refractory insular epilepsy

et al. 2023

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Due to heterogenous seizure semiology and poor contribution of scalp electroencephalography (EEG) signals, insular epilepsy requires use of the appropriate diagnostic tools for its diagnosis and characterization. The deep location of the insula also presents surgical challenges. The aim of this article is to review the current diagnostic and therapeutic tools and their contribution to the management of insular epilepsy. Magnetic resonance imaging (MRI), isotopic imaging, neurophysiological imaging, and genetic testing should be used and interpretated with caution. Isotopic imaging and scalp EEG have demonstrated a lower value in epilepsy from insular compared to temporal origin, which increases the interest of functional MRI and magnetoencephalography. Intracranial recording with stereoelectroencephalography (SEEG) is often required. The insular cortex, being highly connected and deeply located under highly functional areas, is difficult to reach, and its ablative surgery raises functional issues. Tailored resection based on SEEG or alternative curative treatments, such as radiofrequency thermocoagulation, laser interstitial thermal therapy, or stereotactic radiosurgery, have produced encouraging results. The management of insular epilepsy has benefited from major advances in the last years. Perspectives for diagnostic and therapeutic procedures will contribute to better management of this complex form of epilepsy.

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“…The InsCtx generates feelings related to homeostatic states-including fullness, hunger, thirst, nausea, and pain-as well as learned behaviors that elicit and maintain robust responses to cue-rewards, including food and water cues [74][75][76]. Clinically, InsCtx resectioning surgery decreases appetite [77]. The InsCtx processes interoceptive information (visceral, gustatory brain-gut axis, hedonic, etc.)…”

Section: Taste and Food Choicementioning

confidence: 99%

Neurobiology of eating behavior, nutrition, and health

et al. 2023

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Eating behavior and food‐related decision making are among the most complex of the motivated behaviors, and understanding the neurobiology of eating behavior, and its developmental dynamics, is critical to advancing the nutritional sciences and public health. Recent advances from both human and animal studies are revealing that individual capacity to make health‐promoting food decisions varies based on biological and physiological variation in the signaling pathways that regulate the homeostatic, hedonic, and executive functions; past developmental exposures and current life‐stage; the food environment; and complications of chronic disease that reinforce the obese state. Eating rate drives increased calorie intake and represents an important opportunity to lower rates of food consumption and energy intake through product reformulation. Understanding human eating behaviors and nutrition in the context of neuroscience can strengthen the evidence base from which dietary guidelines are derived and can inform policies, practices, and educational programs in a way that increases the likelihood they are adopted and effective for reducing rates of obesity and other diet‐related chronic disease.

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Decreased self-reported appetite following insular cortex resection in patients with epilepsy

Cited by 12 publications

References 45 publications

Sustained, Effortless Weight Loss after Damage to the Left Frontoinsular Cortex: A Case Report

Sustained, Effortless Weight Loss after Damage to the Left Frontoinsular Cortex: A Case Report

Diagnostic and therapeutic approaches in refractory insular epilepsy

Neurobiology of eating behavior, nutrition, and health

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