Does unilateral insular resection disturb personality? A study with epileptic patients

Hébert-Seropian, Benjamin; Boucher, Olivier; Sénéchal, Carole; Rouleau, Isabelle; Bouthillier, Alain; Leporé, Franco; Nguyen, Dang Khoa

doi:10.1016/j.jocn.2017.04.001

Cited by 16 publications

(5 citation statements)

References 27 publications

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“…38 However, changes in personality, with increased irritability, emotional lability, anxiety, and frugality, have been described after insular resections. 39 In our own experience, open surgery was performed in 11 patients, but major deficits (in two patients) or surgical failure due to insufficient resection (in four patients) led us to change our therapeutic strategy to RFTC.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

et al. 2019

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Objective To assess factors associated with favorable outcome in refractory insular epilepsy treated by volume‐based stereotactic radiofrequency thermocoagulation (RFTC). Methods We performed volume‐based RFTC in 19 patients (11 males, 7‐44 years old). The volume for thermocoagulation was identified by multimodal data including electroencephalography (EEG)‐video, magnetic resonance imaging (MRI), and fluorodeoxyglucose–positron emission tomography (PET) in all patients, and epileptogenic zone (EZ) was assessed by stereo‐electroencephalography (SEEG) in 16. MRI showed insular lesions in four patients (benign tumors, n = 2; focal cortical dysplasia [FCD], n = 1; polymicrogyria, n = 1). MRI was negative in 15 cases; however, PET was positive in 18, and FCD pattern was detected by SEEG in nine cases. The dominant hemisphere was involved in 12 cases. RFTC was performed as a separate procedure after SEEG, or as a single MRI‐guided procedure. The insular volume to be coagulated was determined by a tridimensional identification of the epileptogenic cortex using MRI, PET, and SEEG, and was destroyed with coalescent thermal lesions. Results Seizure‐free outcome was achieved in 10 patients (53%), including Engel class IA in three (follow‐up = 1‐12 years, mean = 5.4). The responder rate (including Engel classes I‐III) was 89%. Transient postoperative deficits (mild hemiparesia, dysarthria, hypoesthesia, dysgeusia) were observed in eight patients (42%), with rapid and total recovery in all but one with persistent mild dysarthria. Neurological deficits were related to higher number of RFTC procedures (P = .036) and greater volume of RFTC (P = .028). Neuropsychological status was unchanged or improved in all; however, psychiatric status transitorily worsened in three patients. Factors contributing to seizure‐free outcome were the detection of FCD pattern (P = .009), localized EZ (P = .038), low RFTC volume (P = .002), low number of RFTC procedures (P = .001), and low RFTC volume/number ratio (P = .012). Optimal volume of RFTC around 2 cm3 offered the best compromise between efficacy and safety. Significance RFTC may be curative in insular epilepsy after accurate localization of EZ with SEEG. Best outcome was associated with low volume of thermolesions.

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Section: Discussionmentioning

confidence: 99%

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

et al. 2019

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“…The insula is known to be involved in emotion formation and processing, and insula damage could lead to disruption in these functions. The insula resection group [26] had emotional disturbances postoperatively compared to the temporal cohort.…”

Section: Localization Of Epileptogenic Focus To Be Resected and Perso...mentioning

confidence: 96%

“…One study compared an insular resection group with a TLE cohort [26]. The insular resection group increased in scales of irritability, frugality, anxiety and emotional lability.…”

Section: Influence Of Localization Of Epileptic Foci To Be Resected O...mentioning

confidence: 99%

Personality changes in patients with refractory epilepsy after surgical treatment: A systematic review

Iurina

Baillès²,

Pintor

2021

Seizure

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“…82 Such impairment may lead to personality changes. 84 Alteration of this network may lead to attention deficiency 85 and impaired autobiographical memory. 83 Surgical opening of the sylvian valley carries the risk of injury or spasm of the trunk or branches of the middle cerebral artery.…”

Section: Insular Resectionmentioning

confidence: 99%

“…Impaired emotional processing after insular resection 82,83 could be related to the insular involvement in the salience network 82 . Such impairment may lead to personality changes 84 . Alteration of this network may lead to attention deficiency 85 and impaired autobiographical memory 83 …”

Section: Therapeutic Approaches To Insular Epilepsymentioning

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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Does unilateral insular resection disturb personality? A study with epileptic patients

Cited by 16 publications

References 27 publications

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

Personality changes in patients with refractory epilepsy after surgical treatment: A systematic review

Diagnostic and therapeutic approaches in refractory insular epilepsy

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