title: Complex behavioral automatism arising from insular cortex.
abstract: We describe two cases of complex partial seizures with ictal violent movements arising from the insular cortex. The first patient, a 14-year-old girl, presented with hyperkinetic behavior such as rolling, thrashing, and pedaling, and the second case, a 38-year-old woman, had been suffering from frequent daytime hyperkinetic seizures characterized by bizarre vocalization, jumping, and violent bimanual movements. Both patients showed a slight high signal change in the right posterior ventral insular cortex in fluid-attenuated inversion recovery (FLAIR) studies involving magnetic resonance imaging, and extensive subdural electroencephalographic monitoring revealed EEG seizure onset from the temporal lobe. The posterior ventral insular and lateral temporal cortices were resected, resulting in complete seizure freedom in both cases. The histological diagnoses were focal cortical dysplasia in the first case and gliosis in the second case. There may exist a group of patients with complex partial seizures with ictal violent automatism that can be ameliorated by the resection of epileptogenic lesions in the insular cortex. Careful inspection of the insular cortex is necessary to diagnose this type of epileptic seizure.
authors.affiliation: Department of Neurosurgery, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. kaido@ncnp.go.jp
authors.forename: Takanobu
authors.initials: T
authors.lastname: Kaido
authors.forename: Taisuke
authors.initials: T
authors.lastname: Otsuki
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nakama
authors.forename: Yuu
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kubota
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugai
authors.forename: Osamu
authors.initials: O
authors.lastname: Saito
mesh_terms: D000293:Adolescent; D000328:Adult; D001332:Automatism / Q000503:physiopathology*; D017029:Epilepsy, Complex Partial / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D013702:Temporal Lobe / Q000473:pathology