Perisylvian, including insular, childhood epilepsy: Presurgical workup and surgical outcome

Freri, Elena; Matricardi, Sara; Gozzo, Francesca; Cossu, Massimo; Granata, Tiziana; Tassi, Laura

doi:10.1111/epi.13816

Cited by 52 publications

(44 citation statements)

References 27 publications

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“…Importantly, such findings pertain to older children and adult patients because very few patients younger than 3 years old were included in the present and previous studies. 3 Children younger than 3 years old, as a heterogeneous group, usually present with early motor and tonic seizures in other type of focal epilepsy, including temporal lobe epilepsy. 20 On the other hand, oro-alimentary automatic behavior was rare, observed in only one patient; this is of interest given recent demonstration of the role of insulo-opercular cortex involvement in temporal lobe seizures presenting oro-alimentary automatisms, in which this clinical sign was associated with increased theta coherence between temporal and bilateral insulo-opercular structures.…”

Section: Discussionmentioning

confidence: 99%

“…2 patient belongs to opercular epilepsy according to EI analysis while clinically defined EZ includes opercular and insular cortex according to comprehensive SEEG analysis and clinical information. 3 Part of insular cortex was also included in the resection area according to intro-operative monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…17 Postoperative outcomes were determined by clinic visit or by telephone. Seizure outcomes were established according to Engel's outcome classification system, 3 and Engel class 1 was considered seizure-free after surgery.…”

Section: Surgical Treatment and Postoperative Follow-upmentioning

confidence: 99%

“…In the present patient group, four patients experience postoperative transient mild hemiparesis and persistent mild hemiparesis occurred in two patients due to infarction of long perforated arteries during posterior insular resection, as reported in a previous study. 3 All patients received resection surgery were followed up with a mean duration of 29.2 AE 9.4 months (range: 18-48 months) and 17 patients (80%) were seizure-free at the most recent follow-up after surgery ( Table 2). Three patients without seizure freedom mainly resulted from incomplete resection according to postoperative evaluation: patient 12 presented residual insular cortex in postoperative MRI; patients 18 and 20 presented incomplete resection of precentral operculum, one has fewer habitual seizures and one has focal perioral clonic seizures.…”

Section: Surgery Resection and Pathologymentioning

confidence: 99%

“…Furthermore, the opercular cortex is highly connected to the insular lobe and is commonly included within the epileptogenic onset zone or areas associated with early seizure spread in insular epilepsy. 3,4 Therefore, perisylvian or insulo-opercular epilepsies are often considered an integrated group, and seizure semiology 4 and electroencephalography (EEG) 5 features of such epilepsy have been investigated. SEEG has been approved ª 2019 The Authors.…”

Section: Introductionmentioning

confidence: 99%

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Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study

Wang

McGonigal

et al. 2019

Ann Clin Transl Neurol

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Objective To report clinical experience with presurgical evaluation in patients with insulo‐opercular epilepsy. Quantitative analysis on PET imaging and stereoelectroencephalography (SEEG) signals was used to summarize their electroclinical features. Methods Twenty‐two patients with focal epilepsy arising from the insular and/or opercular cortex according to SEEG were retrospectively analyzed. Presurgical noninvasive data were analyzed in detail. Interictal PET data of patients were then statistically compared with those of healthy controls to identify the interictal hypometabolic network. The epileptogenicity index (EI) of ictal SEEG signal was computed to identify areas of spread at the beginning of seizure onset. Results Focal tonic seizures of the face and/or neck (16/22, 73%) were the most prevalent early objective signs. Epileptic discharges in the interictal and ictal scalp‐EEG mostly showed an ipsilateral perisylvian distribution. Statistical analysis of interictal PET showed significant hypometabolism in the insular lobe, central operculum, supplementary motor area, middle cingulate cortex, bilateral caudate nuclei, and putamen. According to the EI analysis, insulo‐opercular epilepsy could be classified as insulo‐opercular epilepsy (50%), opercular epilepsy (41%), and insular cortex epilepsy (9%). Significance Clinical diagnosis of insulo‐opercular epilepsy is challenging because of its complex seizure semiology and nonlocalizing discharges on scalp‐EEG. A common hypometabolic network involving the insulo‐opercular cortex, mesial frontal cortex and subcortical nuclei may be involved in the organization of the insulo‐opercular epilepsy network. Furthermore, quantified SEEG analysis suggested that pure insular epilepsy is rare, and the close connection between insular and opercular cortex necessitates SEEG implantation to define the epileptogenic zone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Treatment and Postoperative Follow-upmentioning

confidence: 99%

Section: Surgery Resection and Pathologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study

Wang

McGonigal

et al. 2019

Ann Clin Transl Neurol

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Mapping the Insula with Stereo‐Electroencephalography: The Emergence of Semiology in Insula Lobe Seizures

Singh

Príncipe

Tadel

et al. 2020

Annals of Neurology

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Objective Insula epilepsy is rare and can be evaluated effectively by Stereotactic intracerebral EEG (SEEG). Many previous studies of insulo‐opercular seizures have been unable to separate insular and opercular onset. With adequate sampling of the insula, this study shows this is possible. Methods We analyzed intrainsular dynamics and extrainsular propagation in 12 patients with “pure” insula epilepsy (n = 9) or insular and only deepest opercular involvement (n = 3) at seizure onset. Review of semiology defined clinical groups, agglomerative cluster, and principal component analysis of semiological features were performed. Quantitative epileptogenicity, and intrainsular and extrainsular propagation were computed via time frequency analysis and epileptogenicity mapping. Results Seizure onset patterns were heterogeneous; the seizure onset zone was focal. Seizure onset and first ictal change within insula functional subdivision correlated with aura and reflex component. No paninsular spread occurred; contralateral insular spread was very early. While the discharge was intrainsular, clinical signs related to aura or vegetative signs. Extrainsular propagation was early and related to the emergence of the majority of clinical signs. Cluster analysis found an anterior, intermediate, and posterior insula seizure onset group. The largest principal component separated anterior insula manifestations, including early hypermotor signs, early recovery, and no aura from posterior insula features of early dystonia, early tonic motor features, and sensorimotor aura. Interpretation Aura is vital to identifying seizure onset and relates to insula functional subdivision. Seizures are heterogenous; extrainsular propagation occurs early, accounting for most of the semiology. With adequate sampling, "pure" insula epilepsy can be identified and focal curative resection is possible. ANN NEUROL 2020;88:477–488

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Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

et al. 2022

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Insular epilepsy (IE) is an increasingly recognized cause of drug-resistant epilepsy amenable to surgery. However, concerns of suboptimal seizure control and permanent neurological morbidity hamper widespread adoption of surgery for IE.We performed a systematic review and individual participant data meta-analysis to determine the efficacy and safety profile of surgery for IE and identify predictors of outcomes. Of 2483 unique citations, 24 retrospective studies reporting on 312 participants were eligible for inclusion. The median follow-up duration was 2.58 years (range, 0-17 years), and 206 (66.7%) patients were seizure-free at last follow-up. Younger age at surgery

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Perisylvian, including insular, childhood epilepsy: Presurgical workup and surgical outcome

Abstract: The assessment of perisylvian/insular epilepsy in children is particularly challenging. However, tailored resections based on a careful presurgical evaluation, including SEEG recording, may lead to a good seizure control and to a better overall outcome.

Cited by 52 publications

References 27 publications

Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study

Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study

Mapping the Insula with Stereo‐Electroencephalography: The Emergence of Semiology in Insula Lobe Seizures

Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

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