Avoid falling into the depths of the insular trap

Détails

ID Serval
serval:BIB_4393B03B5BF5
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Etude de cas (case report): rapporte une observation et la commente brièvement.
Collection
Publications
Titre
Avoid falling into the depths of the insular trap
Périodique
Epileptic Disord
Auteur⸱e⸱s
Ryvlin P.
ISSN
1294-9361 (Print)
ISSN-L
1294-9361
Statut éditorial
Publié
Date de publication
08/2006
Volume
8 Suppl 2
Pages
S37-56
Langue
anglais
Notes
Ryvlin, Philippe
eng
Case Reports
France
Epileptic Disord. 2006 Aug;8 Suppl 2:S37-56.
Résumé
Recent data have demonstrated that insular seizures can mimic those encountered in temporal lobe epilepsy (TLE), as well as nocturnal hypermotor attacks suggestive of nocturnal frontal lobe epilepsy (NFLE). To illustrate some of the issues raised by these observations, we report our first two patients with suspected TLE and NFLE, respectively, in whom we originally demonstrated an insular ictal onset zone. Patient 1 suffered from daytime seizures characterised by a rising and distressing epigastric sensation rapidly followed by oro-alimentary automatisms, associated with right temporal scalp-EEG ictal discharge. Neuroimaging showed consistent right temporal abnormalities, including MRI signs of hippocampal sclerosis, anterior and mesial glucose hypometabolism, and mesial decrease of benzodiazepine receptors. Intra-cerebral EEG investigation was primarily performed because of several ictal signs and symptoms suggesting a rapid involvement of the perisylvian region, and showed that the patient suffered two types of seizure, one of which arose from the mesial temporal structures, the other was sleep-related and originated in the posterior-inferior portion of the insula. Anterior temporal lobectomy failed to control this second type of seizure. Patient 2 suffered from brief, nocturnal, hypermotor seizures characterised by an indefinable aura followed by agitation, body rolling, scream and pelvic thrust. Interictal and ictal scalp-EEG failed to detect epileptiform discharges, whereas neuroimaging showed left mesial frontal, glucose hypometabolism and decreased benzodiazepine receptors associated with a left fronto-basal arachnoidal cyst. Invasive EEG monitoring was performed with the aim of identifying an orbital or mesial frontal ictal onset, but eventually demonstrated that the seizure originated in the anterior-superior portion of the left insula. The patient did not undergo surgery and died of SUDEP two years later. We discuss the heterogeneity of insular seizure semiology according to functional anatomy, the clinical signs and symptoms that might suggest an insular ictal onset, the indications and types of invasive EEG monitoring that are needed to identify an insular epileptogenic zone definitively, as well as potential surgical treatment.
Mots-clé
Adult, Cerebral Cortex/*physiopathology, Circadian Rhythm, Diagnosis, Differential, Electroencephalography, Epilepsy, Frontal Lobe/*diagnosis, Epilepsy, Temporal Lobe/*diagnosis/surgery, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Seizures/*etiology
Pubmed
Création de la notice
29/11/2018 12:37
Dernière modification de la notice
20/08/2019 13:47
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