Department of Neurology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Brussels, Belgium.
Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium.
Epilepsia. 2023 Jun;64(6):1409-1423. doi: 10.1111/epi.17571. Epub 2023 Mar 30.
Due to heterogenous seizure semiology and poor contribution of scalp electroencephalography (EEG) signals, insular epilepsy requires use of the appropriate diagnostic tools for its diagnosis and characterization. The deep location of the insula also presents surgical challenges. The aim of this article is to review the current diagnostic and therapeutic tools and their contribution to the management of insular epilepsy. Magnetic resonance imaging (MRI), isotopic imaging, neurophysiological imaging, and genetic testing should be used and interpretated with caution. Isotopic imaging and scalp EEG have demonstrated a lower value in epilepsy from insular compared to temporal origin, which increases the interest of functional MRI and magnetoencephalography. Intracranial recording with stereo-electroencephalography (SEEG) is often required. The insular cortex, being highly connected and deeply located under highly functional areas, is difficult to reach, and its ablative surgery raises functional issues. Tailored resection based on SEEG or alternative curative treatments, such as radiofrequency thermocoagulation, laser interstitial thermal therapy, or stereotactic radiosurgery, have produced encouraging results. The management of insular epilepsy has benefited from major advances in the last years. Perspectives for diagnostic and therapeutic procedures will contribute to better management of this complex form of epilepsy.
由于癫痫发作的半侧症状表现具有异质性，且头皮脑电图（EEG）信号的贡献有限，因此需要使用适当的诊断工具来对岛叶癫痫进行诊断和特征描述。岛叶位置较深，这也给手术带来了挑战。本文旨在回顾目前的诊断和治疗工具及其对岛叶癫痫管理的贡献。磁共振成像（MRI）、同位素成像、神经生理学成像和基因检测都应谨慎使用和解读。与颞叶起源的癫痫相比，同位素成像和头皮 EEG 在岛叶起源的癫痫中的价值较低，这增加了功能 MRI 和脑磁图的应用兴趣。立体脑电图（SEEG）的颅内记录通常是必需的。岛叶皮层连接高度复杂，位置深，位于高度功能区下方，难以触及，其切除手术会引发功能问题。基于 SEEG 的针对性切除或替代治疗方法，如射频热凝、激光间质热疗或立体定向放射外科，已经取得了令人鼓舞的结果。近年来，岛叶癫痫的治疗取得了重大进展。诊断和治疗程序的展望将有助于更好地管理这种复杂形式的癫痫。
