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2 results

  • Chapter 10 - The Role of the Insula in Temporal Lobe Epilepsy and Temporal Lobe “Plus” Epilepsies

  • from Section 2 - The Spectrum of Epilepsies Involving the Insula
  • Edited by Dang Nguyen, Université de Montréal, Jean Isnard, Philippe Kahane
  • Book:
    Insular Epilepsies
    Published online:
    09 June 2022
    Print publication:
    24 March 2022, pp 110-117

  • Summary

    The role of the insula in temporal and temporal plus epilepsies has been poorly investigated. The insula is buried deep within the lateral sulcus and has dense connections with neighbored regions, thus limiting the usefulness of available non-invasive diagnostic tools, such as scalp EEG, SPECT, and 18FDG-PET. Also, clinical features related to the involvement of the insula might be misleading, thus making it mandatory to use invasive EEG recordings in most cases. In fact, only a primary involvement of the insula in the epileptogenic network may require to include this area in the resection to achieve seizure freedom. Using modern neurosurgical techniques, insular epilepsy surgery has proved to be safe and beneficial in carefully investigated cases; however, its efficacy remains to be fully elucidated.

  • Seizure Freedom in Temporal Plus Epilepsy Surgery Following Stereo-Electroencephalography

  • Juan S. Bottan, Ana Suller Marti, Andrew G. Parrent, Keith W. MacDougall, Richard S. McLachlan, Jorge G. Burneo, David A. Steven
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 47 / Issue 3 / May 2020
    Published online by Cambridge University Press:
    10 February 2020, pp. 374-381
    • Article
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  • Background:

    “Temporal plus” epilepsy (TPE) is a term that is used when the epileptogenic zone (EZ) extends beyond the boundaries of the temporal lobe. Stereotactic electroencephalography (SEEG) has been essential to identify additional EZs in adjacent structures that might be part of the temporal lobe/limbic network.

    Objective:

    We present a small case series of temporal plus cases successfully identified by SEEG who were seizure-free after resective surgery.

    Methods:

    We conducted a retrospective analysis of 156 patients who underwent SEEG in 5 years. Six cases had TPE and underwent anterior temporal lobectomy (ATL) with additional extra-temporal resections.

    Results:

    Five cases had a focus on the right hemisphere and one on the left. Three cases were non-lesional and three were lesional. Mean follow-up time since surgery was 2.9 years (SD ± 1.8). Three patients had subdural electrodes investigation prior or in addition to SEEG. All patients underwent standard ATL and additional extra-temporal resections during the same procedure or at a later date. All patients were seizure-free at their last follow-up appointment (Engel Ia = 3; Engel Ib = 2; Engel Ic = 1). Pathology was nonspecific/gliosis for all six cases.

    Conclusion:

    TPE might explain some of the failures in temporal lobe epilepsy surgery. We present a small case series of six patients in whom SEEG successfully identified this phenomenon and surgery proved effective.