Epileptic seizure propagation from the second somatic sensory area to the fronto-medial region, by insular redistribution. A case report and a connectome description
Languages of publication
Introduction. The seizure propagation phenomenon by inducing remote symptoms brings several difficulties in finding the seizure onset and delineating the epileptic network which should be taken into consideration in epilepsy surgery. By demonstrating a difficult (MRI negative) epilepsy surgery case explored with invasive presurgical evaluation we highlight the importance to recognise the secondary sensory area and to explore the the parieto-opercular-insular-medial frontal network in certain cases. A further conclusion is the consideration of the redistributory role of the insula as a special structure in the cerebral connectome, having a role in epileptic network organisation.Aims. To support the role of the insula in the organisation of an opercular – medial frontal epileptic network and to confirm Penfield’s the “second somatic sensory leg area” by way of a case report. We try to give an up to date exploration of our patient’s remote epileptic seizures by way of a connectome.Methods. The epileptic disorder was studied with intensive video EEG monitoring and two times 3T MRI. Interictal FDG (fluorodeoxyglucose) PET was also undertaken. Beside the scalp EEG and computerized frequency analysis, the evaluation was performed by invasive EEG with 2 grids and 2 strips and an insular deep electrode in addition. Electrical cortical stimulation and cortical mapping were also undertaken.Results. The video-EEG study revealed the complex seizure semiology. The left sided global somatosesensory aura in the leg, followed supplementary motor area manifestations represented a remote seizure. The seizure onset zone and the symptomatogenic zone were localised by the invasive electrophysiology. With the insular deep electrode we succeeded to explore the propagation of ictal activity to the insula and later to frontal medial surface. The PET, the negative 3T MRI results and the postprocessing morphometry confirmed the lesional origin and localised the epileptogenic area to the second somato-sensory field where a dysgenesis was located.Conclusions. By preoperative invasive video-EEG evaluation, the second somato-sensory leg area was delineated as the seizure onset zone. The resection of this area by IIb type cortical dysgenesis, resulted in a complete relief of the seizures. The invasive video-EEG revealed the peculiar role of the insula in the propagation of the epileptic seizure from the second sensory leg area to the ipsilateral fronto-medial supplemetary motor area. Our results, confirm, that the insula has a relay or node function on the parietal opercular-fronto-medial epileptic network. The connectome of the insula is a further additive of the scale-free features of the remote epileptic networks.
1 - 6 - 2015
14 - 1 - 2015
16 - 5 - 2015
18 - 2 - 2015
- Capital and Regional Center of Epilepsy, St. Stephen Hospital, Budapest, Hungary, firstname.lastname@example.org
- Institute of Experimental Medicine, Budapest, Hungary
- National Institute of Clinical Neuroscience, Budapest, Hungary
- National Institute of Clinical Neuroscience, Budapest, Hungary
- Afif A., Minotti L., Kahane P., Hoffmann D.:Anatomofunctional organisation of the insular cortex: A study using intracrebral electrical stimulation in epileptic patients. Epilepsia, 2010, 51: 2305–2315.
- Balogh A.:Role of the insula in frontal and temporal lobe seizure propagation. Epileptologia, 2011, 19: 17–28.
- Bartolomei F., Bettus G., Stam C.J., Guye M.:Interictal network properties in mesial temporal lobe epilepsy: A graph theoretical study from intracerebral recordings. Clin. Neurophysiol., 2013, 124: 2345–2353.[Crossref][PubMed][WoS]
- van Diessen E., Diederen S.J., Braun K.P., Jansen F.E., Stam C.J.:Functional and structural brain networks in epilepsy: What have we learned? Epilepsia, 2013, 54: 1855–1865.[Crossref][PubMed]
- Dupont S., Bouilleret V., Hasboum D., Semah F., Baulac M.:Functional anatomy of the insula: new insight from imaging. Surg. Radiol. Anat., 2003, 25: 113–119.[Crossref]
- Friston K.J.:Functional and Effective Connectivity in Neuroimaging A Synthesis. Human Brain Mapping, 1994, 2: 56–78.[Crossref]
- Isnard J., Guenot M., Ostrowsky K., Sindou M., Mauguiére F.:The role of the insular cortex in temporal lobe epilepsy. Ann. Neurol., 2000, 48: 614–623.[Crossref][PubMed]
- Isnard J., Guenot M., Sindou M., Mauguiere F.:Clinical manifestations of insular lobe seizures: a stereo-electroencephalographic study. Epilepsia, 2004, 45: 1079–1090.[PubMed][Crossref]
- Isnard J., Ryvlin P., Mauguiére F.:Insular epilepsy. In: H.O. Lüdres (eds), Textbook of Epilepsy Surgery. Informa UK Ltd., London 2008, 39: 320–333.
- Lemieux L., Daunizeau J., Walker M.C.:Concepts of connectivity and human epileptic activity. Frontiers in Systems Neuroscience, 2011, 5: 12.
- Lüders H., Lesser R.P., Dinner D.S., Hahn J.F., Salanga V., Morris H.H.:The second sensory area Humans: Evoked Potencial and electrical stimulation studies. Ann. Neurol., 1985, 17: 177.[Crossref]
- Mesulam M.M., Mufson E.J.:Insula of the old world monkey. I. Architectonics in the insulo orbito-temporal component of the paralimbic brain. J. Comp. Neurol., 1982, 212: 1–22.
- Munari C., Talairach J., Bonnis A., Szikla G., Bancaud J.:Differential diagnosis between temporal and perisylvian epilepsy in a chirurgical perspective. Acta Neurochirurgica, 1980, 30: 97–110.[Crossref]
- Nguyen D.K., Nguyen D.B., Malak R., Bouthillier A.:Insular cortex epilepsy: an overview. Can. J. Neurol. Sci., 2009, 36, Suppl. 2: 58–62.
- Pandya D.N., Barnes C.L.:Architecture and connections of the frontal lobes. In: E. Perecman (ed), The Frontal Lobes Revisited. New York, IRBN Press 1987, 41–72.
- Park H.J., Friston K.:Structural and functional brain networks: from connections to cognition. Science, 2013, 342: doi: 10.1126/science.1238411.[Crossref]
- Penfield W., Jasper H.:Epilepsy and the Functional Anatomy of the Human Brain. J. and A. Churchill Ltd., London 1954, B. Second Sensory Area, 77–78
- Ryvlin P., Kahane P.:The hidden causes of surgery-resistant temporal lobe epilepsy: extratemporal or temporal plus? Curr. Opin. Neurol., 2005, 18: 125–127.[PubMed][Crossref]
- Sanides F.:The cyto-myeloarchitecture of the human frontal lobe and its relation to phylogenetic differentiation of the cerebral cortex. J. Hirnforsch, 1964, 7: 269–282.
- Sanides F.:Functional architecture of motor and sensory cortices in primates in the light of a new concept of neocortex evolution. In: C. Noback, W. Montagna (eds), Advances in Primatology: The Primate Brain, vol. 2. Appleton-Century-Crofts, New York 1970, 1: 137–208.
- Shelley B.P., Trimble M.R.:The insular lobe of Reil-its anatomico-fuctional, behavioral and neuropsychiatric attributes in humans – a review. World J. Biol. Psychiatry, 2004, 5: 176–200.[Crossref]
- Stam C.J., van Straaten E.C.:The organization of physiological brain networks. Clin. Neurophysiol., 2012, 123: 1067–1087.
- Trevathan E., Cascino G.D.:Partial epilepsy presenting as focal paroxysmal pain. Neurology, 1988, 39: 329.
- Tuxhorn I., Kerdar M.S.:Somatosensory Auras. In: H. Lüders, S. Noachtar (Eds.), Epileptic Seizures: Patophysiology and Clinical Semiology. Churchill Livingstone, Philadelphia – Pennsylvania 2000, 288.
- Tuxhorn I., Kerdar M.S:Somatosensory Auras. In: H. Lüders, S. Noachtar (Eds.), Epileptic Seizures: Pathophysiology and Clinical Semiology. Churchill Livingstone, Philadelphia – Pennsylvania 2000, 23, 294–295.
- Varotto G., Tassi L., Franceschetti S., Spreafico R., Panzica F.:Epileptogenic networks of type II focal cortical dysplasia: A stereo-EEG study. Neuroimage, 2012, 61: 591–598.[WoS]
- Wendling F., Chauvel P., Biraben A., Bartolomei F.:From Intracerebral EEG Signals to Brain Connectivity: Identification of Epileptogenic Networks in Partial Epilepsy. Front. Syst. Neurosci., 2010, 4: 154.[PubMed][Crossref]
Publication order reference