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Clínica de Epilepsia | Trabalhos em Congressos

Clinical and electrographic features of insular epilepsy: similarities to temporal lobe epilepsy

A. Cukiert, C. Forster, M. Andrioli, L. Frayman.

Epilepsy Surgery Program, Hospital Brigadeiro, Sao Paulo SP, Brazil.

Patients with temporal lobe seizures and refractory epilepsy represent the main set of patients currently being treated surgically. Insular epilepsy have been rarely reported and its clinical and electrographic features are poorly understood. The electrographic study of the insula is difficult since it is hidden from the brain surface by the frontal and temporal lobe and accurate sampling from this lobe can only be obtained by depth electrode implantation or intraoperative electrocorticography. M.A.R.V., a 48 years-old woman started having simple partial autonomic and complex partial seizures with automatisms and ictal left arm paresis 8 years prior to admission. Seizure’s frequency was 1 per week until recently when they were reasonably controlled with phenytoin. She had 2 tonic-clonic convulsions 3 months prior to admission. Pre-operative EEG showed a right temporal lobe focus with phase reaversals over the right zygomatic electrode. Neuropsychological testing disclosed right fronto-temporal dysfunction. MRI showed an right anterior insular cavernous angioma. Intraoperative ECoG obtained after spliting of the sylvian fissure showed independent spiking from the insula and temporal lobe and insular spikes that spread to the temporal lobe. The cavernous angioma and the surrounding gliotic tissue were removed and the temporal lobe was left in place. Post-resection ECoG still disclosed independent temporal and insular spiking with a lower frequency. The patient has been seizure-free since surgery. Insular epilepsy may share many clinical and electroencephalographic features with temporal lobe epilepsy and might be kept in mind in the diagnosis of patients with refractory "temporal lobe" epilepsy without the typical MRI findings of mesial temporal sclerosis or cortical abnormalities.