title: Orbitofrontal and insular epilepsy.
abstract: OBJECTIVE
  Orbitofrontal and insular epilepsy are difficult to recognize because clinical presentations are variable and surgical approaches remain difficult.
  
  
  METHODS
  Literature review and review of our own case series including selected cases regarding the clinical manifestation and diagnostic utility of diagnostic tests in orbitofrontal and insular epilepsy.
  
  
  RESULTS
  Orbitofrontal epilepsy presents with either frontal lobe type seizures with hypermotor automatism or temporal lobe type seizures with oroalimentary and manual automatisms depending on the spread pattern. Ictal single photon emission computed tomography (SPECT) and other functional imaging can be helpful, but intracranial electroencephalograms (EEGs) are still required to identify orbitofrontal seizure onset. Insular epilepsy presents with throat constriction and unilateral paresthesias. Preoperative functional imaging methods can be helpful, but exploration of the insula is required to identify unequivocal insular onset. Intracranial EEG in the insula can be performed safely and should be considered in atypical temporal lobe cases.
  
  
  CONCLUSIONS
  Intracranial EEG remains the main diagnostic modality to identify orbitofrontal and insular epilepsy. Newer diagnostic modalities such as high-frequency oscillations, EEG, functional magnetic resonance imaging (fMRI), magnet resonance spectroscopy, and magnet source imaging need to be examined further to establish their diagnostic utility.
authors.affiliation: Department of Neurology, Dartmouth Medical School, Hanover, NH, USA.
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Kriegel
authors.forename: David W
authors.initials: DW
authors.lastname: Roberts
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Jobst
mesh_terms: D001931:Brain Mapping / Q000379:methods*; D058256:Brain Waves; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019579:Neocortex / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D010507:Periodicity; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult