Abstracts

Rationale: To demonstrate the place of Video-Stereoelectroencephalography for defining the electrical pattern and the semiology of the insular epileptic seizures. Methods: Nine patients (5 women and 4 men; age: 14 to 39 years, mean 24 ) were evaluated using Video-Stereoelectroencephalography (VSEEG) for partial refractory epilepsy with the hypothesis of insular seizures. There were 3 cases of Taylor’s dysplasia (diagnosis after surgery) and the remaining 6 patients were considered cryptogenic. MRI was considered as normal in 7 patients and demonstrated a thickening of the insular cortex in 2 of the 3 cases of cortical dysplasia. In all cases PET-scan showed a predominant insular hypometabolism. For each case 1 to 4 electrodes targeted insular cortex and frontal and temporal lobes were also investigated in 6 cases, the frontal lobe also in 1 case and the frontal and the parietal lobes also in 2 cases. Results: Symptoms associated with the initial fast insular discharge were thoracic, abdominal or genital sensation (3 cases), paresthesia of the controlateral upper limb or cheek or inside the mouth (3 cases), throat tightening with a feeling of suffocation (3 cases), vertigo or cephalic sensation (3 cases). Discharge spread was frontal in 4 cases with agitated gesticulation, temporal in 3 cases associated with oroalimentary automatisms and to the inferior central region in 2 cases with tonic posture of the controlateral upper limb. Conclusions: These observations confirm the involvement of insular cortex in generating known electro-clinical seizures patterns and emphasize the importance of considering the insula as a possible seizure onset zone in similar cases.