title: Successful surgical treatment of insular epilepsy with nocturnal hypermotor seizures.
abstract: Nocturnal hypermotor seizures (NHSs) suggest seizure onset in the frontal lobe. We present a patient with NHSs and insular seizure onset who underwent successful surgical treatment. A 29-year-old right-handed man suffered from intractable NHSs since the age of 12 years. High-resolution MRI, [(18)F]FDG-PET, and neuropsychological examination gave normal results, ictal EEG was obscured by artifacts. Ictal [(99m)Tc]HMPAO-SPECT revealed hyperperfusion in the right anterior part of the insula and right frontal operculum. The seizure onset zone was localized in the right anterior insula based on invasive recordings. Electrical stimulation in that area elicited habitual seizures. A limited resection of the anterior part of the right insula and the right frontal operculum was performed rendering the patient seizure-free (follow-up 1 year). To our knowledge, this is the first reported nonlesional patient with an insular seizure onset and NHSs who underwent successful epilepsy surgery.
authors.affiliation: Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Judith
authors.initials: J
authors.lastname: Dobesberger
authors.forename: Martin
authors.initials: M
authors.lastname: Ortler
authors.forename: Iris
authors.initials: I
authors.lastname: Unterberger
authors.forename: Gerald
authors.initials: G
authors.lastname: Walser
authors.forename: Tina
authors.initials: T
authors.lastname: Falkenstetter
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodner
authors.forename: Thomas
authors.initials: T
authors.lastname: Benke
authors.forename: Reto
authors.initials: R
authors.lastname: Bale
authors.forename: Thomas
authors.initials: T
authors.lastname: Fiegele
authors.forename: Eveline
authors.initials: E
authors.lastname: Donnemiller
authors.forename: Thaddaeus
authors.initials: T
authors.lastname: Gotwald
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000601:surgery*; D018572:Disease-Free Survival; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000706:statistics & numerical data; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000000981:diagnostic imaging; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D012640:Seizures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D019690:Technetium Tc 99m Exametazime