Zhuang Jun, Fei Lingxia, Li Hua, Li Kaihui, Tan Qinghua, Li Shaochun, Chen Junxi, Cai Meiling
Department of Epilepsy, Guangdong Sanjiu Brain Hospital, Guangzhou 510510, China.
Department of Epilepsy, Guangdong Sanjiu Brain Hospital, Guangzhou 510510, China.
Epilepsy Res. 2025 Sep;215:107558. doi: 10.1016/j.eplepsyres.2025.107558. Epub 2025 May 1.
Insular epilepsy poses significant diagnostic challenges due to its distinctive anatomical location and heterogeneous clinical manifestations. This study aims to develop a comprehensive classification system based on anatomo-electro-clinical features through stereoelectroencephalography (SEEG) analysis. The research seeks to elucidate the specific correspondence between clinical phenotypes and ictal electro-anatomical propagation patterns, investigate the network dynamics underlying various clinical phenotypes, and establish a theoretical framework for the precise diagnosis and personalized treatment of insular epilepsy.
This single-center retrospective case series included 20 patients with pure insular epilepsy confirmed by stereoelectroencephalography (SEEG) who were treated at Guangdong Sanjiu Brain Hospital between January 2015 and July 2024. The cohort comprised 12 males and 8 females with a mean age of 14.25 ± 9.8 years. All patients underwent individualized SEEG electrode implantation (mean 12.5 ± 2.3 electrodes per patient), comprehensively covering all insular subregions (anterior and posterior insula) and key brain areas in potential propagation pathways. A standardized protocol was employed for systematic analysis of: (1) ictal onset zone localization and electro-anatomical propagation patterns; (2) ictal semiology and clinical phenotype analysis based on video-SEEG recordings; and (3) surgical strategies, pathological findings, and outcome assessment (Engel classification, with follow-up periods ranging from 6 months to 8 years).
The study identified five characteristic clinical phenotypes: the BATS phenotype (35.0 %), tonic-hypermotor phenotype (25.0 %), hypermotor-autonomic phenotype (25.0 %), pure sensory phenotype (10.0 %), and pure autonomic phenotype (5.0 %). These phenotypes demonstrated specific correspondence with six distinct SEEG propagation patterns. Posterior insular epilepsy (70.0 %) preferentially propagated through sensorimotor networks, whereas anterior insular epilepsy (30.0 %) primarily spread via limbic system networks. Focal cortical dysplasia was the predominant pathological finding (94.7 %). All surgical patients (n = 19) achieved Engel Ia outcome, with follow-up periods ranging from 6 months to 8 years.
This study established an anatomo-electro-clinical classification system for insular epilepsy and elucidated the specific correspondence between clinical phenotypes and neuronal network propagation patterns. This correspondence reflects the characteristic propagation of epileptic activity through pre-existing functional connectivity networks, providing a theoretical foundation for the precise diagnosis and personalized treatment of insular epilepsy.
岛叶癫痫因其独特的解剖位置和异质性临床表现而带来重大的诊断挑战。本研究旨在通过立体定向脑电图（SEEG）分析，基于解剖-电-临床特征建立一个综合分类系统。该研究旨在阐明临床表型与发作期电-解剖传播模式之间的具体对应关系，探究各种临床表型背后的网络动力学，并为岛叶癫痫的精确诊断和个性化治疗建立理论框架。
本单中心回顾性病例系列研究纳入了2015年1月至2024年7月在广东三九脑科医院接受治疗的20例经立体定向脑电图（SEEG）确诊的纯岛叶癫痫患者。该队列包括12名男性和8名女性，平均年龄为14.25±9.8岁。所有患者均接受了个体化的SEEG电极植入（平均每位患者12.5±2.3个电极），全面覆盖所有岛叶亚区（岛叶前部和后部）以及潜在传播途径中的关键脑区。采用标准化方案对以下内容进行系统分析：（1）发作起始区定位和电-解剖传播模式；（2）基于视频-SEEG记录的发作期症状学和临床表型分析；（3）手术策略、病理结果和结局评估（Engel分级，随访期为6个月至8年）。
该研究确定了五种特征性临床表型：蝙蝠型表型（35.0%）、强直-多动型表型（25.0%）、多动-自主神经型表型（25.0%）、纯感觉型表型（10.0%）和纯自主神经型表型（5.0%）。这些表型与六种不同的SEEG传播模式表现出特定的对应关系。岛叶后部癫痫（70.0%）优先通过感觉运动网络传播，而岛叶前部癫痫（30.0%）主要通过边缘系统网络传播。局灶性皮质发育不良是主要的病理发现（94.7%）。所有手术患者（n = 19）均达到Engel Ia级结局，随访期为6个月至8年。
本研究建立了岛叶癫痫的解剖-电-临床分类系统，阐明了临床表型与神经网络传播模式之间的具体对应关系。这种对应关系反映了癫痫活动通过预先存在的功能连接网络的特征性传播，为岛叶癫痫的精确诊断和个性化治疗提供了理论基础。
