Clinical manifestations of insular lobe seizures: a stereo-electroencephalographic study
Open accessAbstract
PURPOSE: In this study, we report the clinical features of insular lobe seizures based on data from video and stereo-electroencephalographic (SEEG) ictal recordings and direct electric insular stimulation of the insular cortex performed in patients referred for presurgical evaluation of temporal lobe epilepsy (TLE). METHODS: Since our first recordings of insular seizures, the insular cortex has been included as one of the targets of stereo-electroencephalographic (SEEG) electrode implantation in 50 consecutive patients with TLE whose seizures were suspected to originate from, or rapidly to propagate to, the perisylvian cortex. In six, a stereotyped sequence of ictal symptoms associated with intrainsular discharges could be identified. RESULTS: This ictal sequence occurred in full consciousness, beginning with a sensation of laryngeal constriction and paresthesiae, often unpleasant, affecting large cutaneous territories, most often at the onset of a complex partial seizure (five of the six patients). It was eventually followed by dysarthric speech and focal motor convulsive symptoms. The insular origin of these symptoms was supported by the data from functional cortical mapping of the insula by using direct cortical stimulations. CONCLUSIONS: This sequence of ictal symptoms looks reliable enough to characterize insular lobe epileptic seizures (ILESs). Observation of this clinical sequence at the onset of seizures on video-EEG recordings in TLE patients strongly suggests that the seizure-onset zone is located not in the temporal but in the insular lobe; recording directly from the insular cortex should occur before making any decision regarding epilepsy surgery.
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The highest prevalence of bodily self disturbances was found in the parietal cortex (primary somatosensory cortex: 27.3%) and temporo-insular cortex (24%), whereas the lowest prevalence was found for early whole-brain or temporal cortex mapping by Penfield and colleagues (0.1%−1.8%).
“The highest prevalence was found in the parietal cortex (primary somatosensory cortex: 27.3%; Sun, Zhang, Yu, et al., 2021) and temporo‐insular cortex (24%; Isnard et al., 2004), whereas the lowest prevalence was found for early whole‐brain or temporal cortex mapping by Penfield and colleagues (0.1%−1.8%; Penfield & Perot, 1963; Penfield, 1947, 1955, 1957).”
From Neural bases of the bodily self as revealed by electrical brain stimulation: A systematic review (2023) · cites this paper as Isnard et al., 2004
The Somatosensory responses section reports insular-stimulation responses involving whole-body sensations and feelings of unreality, so the paper supports an association with bodily-self disturbances. It does not report a 24% prevalence for the temporo-insular cortex; it lists each of those response types as 4% of evoked responses. The parietal and Penfield figures are attached to other citations, not Isnard et al. (LLM, conf=0.85)
Experimental — accuracy not yet measuredStudies of epileptic seizures in the insula, stroke-induced lesions to the insula, lesioning studies in rats, and direct electrical stimulation studies in primates have shown the insula is critical for perception, recognition, and working memory in taste.
“Studies of epileptic seizures in the insula (Isnard et al., 2004), stroke-induced lesions to the insula (Pritchard et al., 1999), lesioning studies in rats (DeCoteau et al., 1997; Ragozzino and Kesner, 1999; Fresquet et al., 2004), and direct electrical stimulation studies in primates (Verhagen et al., 2004) have shown the insula is critical for perception, recognition, and working memory in taste”
From The Insula: A Brain Stimulation Target for the Treatment of Addiction (2019) · cites this paper as Isnard et al., 2004
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“…prevalence was found in the parietal cortex (primary somatosensory cortex: 27.3%; Sun, Zhang, Yu, et al., 2021) and temporo-insular cortex (24%; Isnard et al., 2004), whereas the lowest prevalence was found for early whole-brain or temporal cortex mapping by Penfield and colleagues (0.1% 1.8%;…”
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- Authors
- Isnard, J., Guénot, M., Sindou, M., & Mauguière, F.
- Affiliations
- Hospices Civils de Lyon (FR)
- Venue
- Epilepsia
- Publisher
- Wiley
- Published
- 2004-08-24
- Volume
- 45
- Issue
- 9
- Pages
- 1079-1090
- ISSN
- 0013-9580 (ISSN-L)
- 1528-1167
- OpenAlex
- W2052579703
- Cited by
- 504
- References
- 49
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 20 · 2023: 33 · 2022: 30 · 2021: 24 · 2020: 27 · 2019: 37 · 2018: 25 · 2017: 41 · 2016: 26 · 2015: 23 · 2014: 14 · 2013: 25 · 2012: 28
- FWCI
- 7.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epilepsia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › EEG and Brain-Computer Interfaces
- Keywords
- temporal lobe epilepsy, stereoelectroencephalography, seizure onset zone, direct cortical stimulation, insula, complex partial seizures, dysarthric speech, laryngeal constriction, preoperative assessment, epilepsy surgery
- MeSH terms
- Adult, Brain Mapping, Cerebral Cortex, Diagnosis, Differential, Electric Stimulation, Electrodes, Implanted, Electroencephalography, Epilepsy, Temporal Lobe, Female, Humans, Magnetic Resonance Imaging, Male, Monitoring, Physiologic, Neural Pathways, Preoperative Care, Seizures, Stereotaxic Techniques, Temporal Lobe, Video Recording, Treatment Outcome, Epilepsy, Rolandic
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