The role of the insular cortex in temporal lobe epilepsy
The role of the insular cortex in temporal lobe epilepsy
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DOI：
10.1002/1531-8249(200010)48:4
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发表时间：
2000-10
影响因子：
11.2
通讯作者：
J. Isnard;M. Guenot;K. Ostrowsky;M. Sindou;F. Mauguière
中科院分区：
文献类型：
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作者：
J. Isnard;M. Guenot;K. Ostrowsky;M. Sindou;F. Mauguière
在21例药物难治性颞叶癫痫（TLE）患者中，使用81次自发性电临床癫痫发作期间岛叶皮质活动的慢性深度立体定向记录和发作症状的视频记录，研究了岛叶皮质在TLE发作发生中的作用。发现所有记录的癫痫发作均侵入海马，最常见的是在同侧海马中继后（19/21例患者）。然而，2例患者的癫痫发作起源于岛叶皮质本身。与岛叶放电相关的发作症状与通常归因于内侧颞叶癫痫发作的症状相似，因此头皮视频脑电图监测无法区分颞内侧和岛叶放电的发作症状。在17例手术患者中，15例在保留岛叶皮质的颞叶皮质切除术后获得了良好的结局。传播到岛叶皮质的癫痫发作被认为是完全控制的手术，而那些起源于岛叶皮质持续颞叶皮质切除术后。颞叶切除术不影响岛叶皮质癫痫发作的事实可能解释了颞叶癫痫手术失败的原因。《神经学年鉴》2000;48：614-623
The role of the insular cortex in the genesis of temporal lobe epileptic (TLE) seizures has been investigated in 21 patients with drug‐refractory TLE using chronic depth stereotactic recordings of the insular cortex activity and video recordings of ictal symptoms during 81 spontaneous electroclinical seizures. All of the recorded seizures were found to invade the insula, most often after a relay in the ipsilateral hippocampus (19/21 patients). However, 2 patients had seizures that originated in the insular cortex itself. Ictal symptoms associated with the insular discharges were similar to those usually attributed to mesial temporal lobe seizures, so that scalp video‐electroencephalographic monitoring does not permit making any difference between ictal symptoms of temporo‐mesial and insular discharges. A favorable outcome was obtained after a temporal cortectomy sparing the insular cortex in 15 of 17 operated patients. Seizures propagating to the insular cortex were found to be fully controlled by surgery, whereas those originating in the insular cortex persisted after temporal cortectomy. The fact that seizures originating in the insular cortex are not influenced by temporal lobectomy is likely to explain some of the failures of this surgical procedure in TLE. Ann Neurol 2000;48:614–623