title: Insular and insulo-opercular epilepsy in childhood: an SEEG study.
abstract: OBJECTIVE
  In recent years, there have been series analysing the electro-clinical correlations of insular epilepsy in adult populations. In contrast, the ictal semiology in children with insular epilepsy is poorly described. Considering that early and successful surgery may greatly improve the cognitive outcome and quality of life, it is worthwhile to deepen our knowledge of insular epilepsy in children.
  
  
  METHODS
  We retrospectively evaluated ten children with drug-resistant focal insular epilepsy who had been consecutively explored with stereoelectroencephalography (SEEG), followed by individually tailored resective surgery that included part of the insula in all cases. A detailed anatomo-electro-clinical analysis of non-invasive EEG and SEEG data was performed. At least one of the electrodes explored the insular cortex. SEEG analysis confirmed that the insular cortex was included in the ictal onset zone.
  
  
  RESULTS
  Epilepsy onset was mostly during the first year of life, characterized by subtle seizures as well as spasms and myoclonic seizures. Later on, neurovegetative signs and asymmetric tonic and hypermotor seizures (HMS) dominated the ictal semiology. The epileptogenic zone was frequently wider than insular with frontal and central predominance. In eight patients, the tailored resection included a lesion. In seven patients, an Engel class 1 outcome as well as neuropsychological and behavioural improvement was obtained.
  
  
  CONCLUSIONS
  SEEG is feasible and useful in children with drug-resistant insular epilepsy which is often characterized by autonomic symptoms as the initial symptoms and should be suspected in cases with HMS, asymmetric tonic seizures and even asymmetric spasms. Early propagation is mostly frontal and central. Analysis of a larger population is required to refine these findings.
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France.
authors: S
authors: S
authors: Dylgjeri
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France. Electronic address: dtaussig@fo-rothschild.fr.
authors: D
authors: D
authors: Taussig
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France.
authors: M
authors: M
authors: Chipaux
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France; Department of Neurophysiology, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France.
authors: A
authors: A
authors: Lebas
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France.
authors: M
authors: M
authors: Fohlen
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France; Inserm, U663, Paris F-75015, France; University Paris Descartes, 75005 Paris, France.
authors: C
authors: C
authors: Bulteau
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France.
authors: J
authors: J
authors: Ternier
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France.
authors: S
authors: S
authors: Ferrand-Sorbets
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France.
authors: O
authors: O
authors: Delalande
authors: Hospices civils de Lyon, Hôpital Neurologique; Service de Neurologie Fonctionnelle et d'Epileptologie, 69677 Bron, France.
authors: J
authors: J
authors: Isnard
authors: Service de Neurochirurgie Pédiatrique, Fondation Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France; Inserm, U663, Paris F-75015, France; University Paris Descartes, 75005 Paris, France.
authors: G
authors: G
authors: Dorfmüller
mesh_terms: D000328:Adult; D017668:Age of Onset; D058256:Brain Waves / Q000502:physiology*; D002540:Cerebral Cortex / Q000473:pathology*; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D013238:Stereotaxic Techniques
keywords: Child; Epilepsy surgery; Focal epilepsy; Insula; Invasive exploration; SEEG