Isnard J, Guénot M, Ostrowsky K, Sindou M, Mauguière F
Functional Neurology and Epileptology, Department Neurological Hospital, Lyon, France.
Ann Neurol. 2000 Oct;48(4):614-23.
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.
利用慢性深度立体定向记录岛叶皮质活动以及81次自发性电临床发作期间的发作症状视频记录，对21例药物难治性颞叶癫痫（TLE）患者岛叶皮质在颞叶癫痫发作起源中的作用进行了研究。发现所有记录的发作均侵袭岛叶，最常见的是在同侧海马中继后（21例患者中有19例）。然而，有2例患者的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颞叶内侧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叶内侧和岛叶放电的发作症状。17例接受手术的患者中有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果。发现传播至岛叶皮质的发作可通过手术完全控制，而起源于岛叶皮质的发作在颞叶皮质切除术后仍持续存在。起源于岛叶皮质的发作不受颞叶切除术影响这一事实，可能解释了该手术在TLE中某些失败的原因。
