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Invasive EEG Investigation of the Insula 

Invasive EEG Investigation of the Insula
Chapter:
Invasive EEG Investigation of the Insula
Author(s):

Philippe Ryvlin

, and Fabienne Picard

DOI:
10.1093/med/9780198714668.003.0027
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date: 20 September 2019

Invasive EEG investigation of the insular cortex is performed in various forms of focal drug-resistant epilepsies, including patients with a clear-cut intra-insular epileptogenic lesion, such as focal cortical dysplasia, as well as patients whose non-invasive presurgical evaluation suggests perisylvian epilepsy, temporal plus epilepsy, sleep hypermotor epilepsy, or MRI-negative frontal or parietal lobe epilepsy. Stereo-EEG (SEEG) is currently the preferred method for investigating the insula, using orthogonal or oblique trajectories, or a combination, with no evidence of higher risk of intracranial bleeding than in other brain regions. Intra-insular ictal EEG patterns are often characterized by a prolonged focal discharge restricted to one of the five insular gyri, requiring dense sampling of the insular cortex in suspected insular epilepsies. SEEG also offers the potential to perform thermolesion of insular epileptogenic zones, which, together with MRI-guided laser ablation, represents a possibly safer alternative to open-skull surgical resection of the insula.

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