Refractory insular cortex epilepsy: clinical features, investigation and treatment

Abstract

A significant percentage of patients continue to present with seizures after epilepsy surgery. Among the multiple causes, the most obvious ones include failure to remove all of the epileptogenic tissue or incorrect localization of the epileptogenic zone. Recent evidence has shown that failure to recognize insular cortex seizures may be responsible for some of these surgical failures. First, insular seizures may mimic temporal, parietal or frontal lobe seizures. Second, insular seizures may coexist with seizures from other lobes. In this article, we review recently published data on the role of the insula in refractory partial epilepsy, the appropriate investigation and surgical therapy for this seizure entity.