Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-24T19:07:22.306Z Has data issue: false hasContentIssue false

Chapter 14 - Structural Imaging of Insular Epilepsy

from Section 3 - Noninvasive Investigation of Insular Epilepsy

Published online by Cambridge University Press:  09 June 2022

By
Andreas V. Alexopoulos
Edited by
Dang Nguyen ,
Jean Isnard  and
Philippe Kahane
Dang Nguyen
Affiliation:
Université de Montréal
Jean Isnard
Affiliation:
Claude Bernard University Lyon
Philippe Kahane
Affiliation:
Grenoble-Alpes University Hospital
Get access

Summary

Structural brain MRI is an indispensable tool in the diagnosis and management of patients with insular epilepsy. Similar to the pathology of other focal epilepsies MRI lesions span from the obvious to the occult cortical malformations, along with vascular malformations, neoplasms, encephaloclastic lesions (e.g., after stroke or trauma), and less frequent etiologies including Rasmussen encephalitis. The incidence of MRI-negative focal epilepsy arising from the insula is unknown. Appropriate epilepsy MRI protocol is a necessary, but not sufficient requirement for the structural exploration of the insula. Interpretation of the study strongly depends on the reader’s expertise in imaging of epilepsy. Advances in image processing and multimodality imaging have increased the diagnostic yield of MRI studies in nonlesional insular epilepsies and in particular in patients with occult focal cortical dysplasia, including bottom of the sulcus dysplasia. The utility of emerging approaches, such as 7-Tesla and quantitative MRI studies, in the evaluation of insular epilepsies is now being explored. Finally, the importance of re-interpreting each visually identifiable MRI lesion or postprocessing MRI finding in the context of the individual clinical presentation cannot be overemphasized.

Keywords

insular epilepsyneuroimagingstructural MRIadvanced MRIquantitative MRIhigh field MRI
Type
Chapter
Information
Insular Epilepsies , pp. 163 - 178
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Von Bonin, G, Bailey, P. The Neocortex of Macaca mulatta. J Am Med Assoc. 1948;137(12):1093. doi:10.1001/jama.1948.02890460089032.Google Scholar
Chen, BY, Boucher, O, Dugas, C, Nguyen, DK, Gioia, L. Insular Ischemic Stroke. In: Turgut, M, Yurttaş, C, Tubbs, RS, eds. Island of Reil (Insula) in the Human Brain: Anatomical, Functional, Clinical and Surgical Aspects.Springer; 2018: 203.Google Scholar
Nieuwenhuys, R. The insular cortex. A review. In: Progress in Brain Research. Vol. 195. Elsevier B.V.; 2012: 123–163. doi:10.1016/B978-0-444-53860-4.00007-6.Google Scholar
Türe, U, DCH, Yaşargil, Al-Mefty, O, Yaşargil, MG. Topographic anatomy of the insular region. J Neurosurg. 1999;90(4):720–733. doi:10.3171/jns.1999.90.4.0720.CrossRefGoogle ScholarPubMed
Guenot, M, Isnard, J, Sindou, M. Surgical anatomy of the insula. Adv Tech Stand Neurosurg. 2004. doi:10.1007/978-3-7091-0558-0_7.Google Scholar
Jobst, BC, Gonzalez-Martinez, J, Isnard, J, et al. The insula and its epilepsies. Epilepsy Curr. 2019;19(1):11–21. doi:10.1177/1535759718822847.Google Scholar
TP, Naidich, Kang, E, GM, Fatterpekar, et al. The insula: Anatomic study and MR imaging display at 1.5 T. AJNR Am J Neuroradiol 2004;25(2):222–232.Google Scholar
Gaillard, WD, Cross, JH, Duncan, JS, Stefan, H, Theodore, WH. Epilepsy imaging study guideline criteria: Commentary on diagnostic testing study guidelines and practice parameters. Epilepsia. 2011;52(9):1750–1756. doi:10.1111/j.1528-1167.2011.03155.x.Google Scholar
Bernasconi, A, Cendes, F, Theodore, WH, et al. Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force. Epilepsia. 2019;60(6):1054–1068. doi:10.1111/epi.15612.Google Scholar
Nguyen, DK, Nguyen, DB, Malak, R, et al. Revisiting the role of the insula in refractory partial epilepsy. Epilepsia. 2009;50(3):510–520. doi:10.1111/j.1528-1167.2008.01758.x.CrossRefGoogle ScholarPubMed
Laoprasert, P, Ojemann, JG, Handler, MH. Insular epilepsy surgery. Epilepsia. 2017;58:35–45. doi:10.1111/epi.13682.Google Scholar
Chevrier, MC, Bard, C, Guilbert, F, Nguyen, DK. Structural abnormalities in patients with insular/peri-insular epilepsy: spectrum, frequency, and pharmacoresistance. Am J Neuroradiol. 2013;34(11):2152–2156. doi:10.3174/ajnr.A3636.Google Scholar
Mohamed, AR, Bailey, CA, Freeman, JL, Maixner, W, Jackson, GD, Harvey, FAS. Intrinsic Epileptogenicity of Cortical Tubers Revealed by Intracranial EEG Monitoring Neurology. 2012; 79(23):2249–2257. doi:10.1212/wnl.0b013e3182768923.Google Scholar
Kuzniecky, R, Andermann, F. The Congenital Bilateral Peri-Sylvian Syndrome: Imaging Findings in a Multicenter Study. Am J Neuroradiol. 1994;15(1):139–144.Google Scholar
Potts, MB, Young, WL, Lawton, MT. Deep arteriovenous malformations in the basal ganglia, thalamus, and insula: Microsurgical management, techniques, and results. Neurosurgery. 2013;73(3):417–429. doi:10.1227/NEU.0000000000000004.Google Scholar
Jaiswal, M. Insular Cortex Epilepsy. In: Turgut, M, Yurttaş, C, RS, Tubbs, eds., Island of Reil (Insula) in the Human Brain: Anatomical, Functional, Clinical and Surgical Aspects. Springer; 2018: 199–200.Google Scholar
Varadkar, S, Bien, CG, Kruse, CA, et al. Rasmussen’s encephalitis: Clinical features, pathobiology, and treatment advances. Lancet Neurol. 2014;13(2):195–205. doi:10.1016/S1474-4422(13)70260-6.Google Scholar
Ryvlin, P, Minotti, L, Demarquay, G, et al. Nocturnal hypermotor seizures, suggesting frontal lobe epilepsy, can originate in the insula. Epilepsia. 2006;47(4):755-765.doi:10.1111/j.1528-1167.2006.00510.x.Google Scholar
Isnard, J, Guénot, M, Sindou, M, Mauguière, F. Clinical manifestations of insular lobe seizures: A stereo- electroencephalographic study. Epilepsia. 2004;45(9):1079–1090. doi:10.1111/j.0013-9580.2004.68903.x.Google Scholar
Bouthillier, A, Nguyen, DK. Epilepsy surgeries requiring an operculoinsular cortectomy: Operative technique and results. Clin Neurosurg. 2017;81(4):602–611. doi:10.1093/neuros/nyx080.Google Scholar
Dylgjeri, S, Taussig, D, Chipaux, M, et al. Insular and insulo-opercular epilepsy in childhood: An SEEG study. Seizure. 2014;23(4):300–308. doi:10.1016/j.seizure.2014.01.008.Google Scholar
Weil, AG, Le, NMD, Jayakar, P, et al. Medically resistant pediatric insular-opercular/peri-Sylvian epilepsy. Part 2: Outcome following resective surgery.J Neurosurg Pediatr. 2016;18(5):523–535. doi:10.3171/2016.4.PEDS15618.Google Scholar
Bernasconi, A, Bernasconi, N, Bernhardt, BC, Schrader, D. Advances in MRI for “cryptogenic” epilepsies. Nat Rev Neurol. 2011;7(2):99–108. doi:10.1038/nrneurol.2010.199.Google Scholar
Bastos, AC, Comeau, RM, Andermann, F, et al. Diagnosis of subtle focal dysplastic lesions: Curvilinear reformatting from three-dimensional magnetic resonance imaging. Ann Neurol. 1999;46(1):88–94. doi:10.1002/1531-8249(199907)46:1<88::AID-ANA13>3.0.CO;2-4.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Bernasconi, A. Structural analysis applied to epilepsy. In: RI, Kuzniecky, GD, Jackson, eds., Magnetic Resonance in Epilepsy. 2nd ed. Academic Press; 2005: 249–269.Google Scholar
Cendes, F, Theodore, WH, Brinkmann, BH, Sulc, V, Cascino, GD. Neuroimaging of Epilepsy. Vol. 136. 1st ed. Elsevier B.V.; 2016. doi:10.1016/B978-0-444-53486-6.00051-X.Google Scholar
Wang, ZI, Alexopoulos, A V., Jones, SE, Jaisani, Z, Najm, IM, Prayson, RA. The pathology of magnetic-resonance-imaging-negative epilepsy. Mod Pathol. 2013;26(8):1051–1058. doi:10.1038/modpathol.2013.52.CrossRefGoogle ScholarPubMed
Wang, ZI, Alexopoulos, AV, Jones, SE, et al. Linking MRI postprocessing with magnetic source imaging in MRI-negative epilepsy. Ann Neurol. 2014;75(5). doi:10.1002/ana.24169.Google Scholar
Wang, ZI, Jones, SE, Jaisani, Z, et al. Voxel-based morphometric magnetic resonance imaging (MRI) postprocessing in MRI-negative epilepsies. Ann Neurol. 2015;77(6):1060–1075. doi:10.1002/ana.24407.Google Scholar
Bernasconi, A, Antel, SB, Collins, DL, et al. Texture analysis and morphological processing of magnetic resonance imaging assist detection of focal cortical dysplasia in extra-temporal partial epilepsy. Ann Neurol. 2001;49(6):770–775. doi:10.1002/ana.1013.Google Scholar
Kassubek, J, Huppertz, HJ, Spreer, J, Schulze-Bonhage, A. Detection and localization of focal cortical dysplasia by voxel-based 3-D MRI analysis. Epilepsia. 2002;43(6):596–602. doi:10.1046/j.1528-1157.2002.41401.x.CrossRefGoogle ScholarPubMed
Huppertz, HJ, Grimm, C, Fauser, S, et al. Enhanced visualization of blurred gray-white matter junctions in focal cortical dysplasia by voxel-based 3D MRI analysis. Epilepsy Res. 2005;67(1–2):35–50. doi:10.1016/j.eplepsyres.2005.07.009.Google Scholar
Wang, IZ, Ristic, AJ, Wong, CH, et al. Neuroimaging characteristics of MRI-negative orbitofrontal epilepsy with focus on voxel-based morphometric MRI postprocessing. Epilepsia. 2013;54(12):2195–2203. doi:10.1111/epi.12390.Google Scholar
Wang, S, Jin, B, Aung, T, et al. Application of MRI Post-processing in presurgical evaluation of non-lesional cingulate epilepsy. Front Neurol. 2018;9 (Nov.):1–7. doi:10.3389/fneur.2018.01013.Google Scholar
Wang, S, Tang, Y, Aung, T, et al. Multimodal noninvasive evaluation in MRI-negative operculoinsular epilepsy. J Neurosurg. 2019:1–11. doi:10.3171/2018.12.JNS182746.Google Scholar
Blümcke, I, Thom, M, Aronica, E, et al. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia. 2011;52(1):158–174. doi:10.1111/j.1528-1167.2010.02777.x.Google Scholar
Engel, JJ, Van Ness, PC, Rasmussen, TB, Ojemann, LM. Outcome with respect to epileptic seizures. In: Engel J., Jr (ed). Surgical Treatment of the Epilepsies, ed 2.: Raven Press, 1993:609–621.Google Scholar
Besson, P, Andermann, F, Dubeau, F, Bernasconi, A. Small focal cortical dysplasia lesions are located at the bottom of a deep sulcus. Brain. 2008;131(12):3246–3255. doi:10.1093/brain/awn224.Google Scholar
Hofman, PAM, Fitt, GJ, Harvey, AS, Kuzniecky, RI, Jackson, G. Bottom-of-sulcus dysplasia: Imaging features. Am J Roentgenol. 2011;196(4):881–885. doi:10.2214/AJR.10.4423.Google Scholar
Ying, Z, Wang, I, Blümcke, I, et al. A comprehensive clinico-pathological and genetic evaluation of bottom-of-sulcus focal cortical dysplasia in patients with difficult-to-localize focal epilepsy. Epileptic Disord. 2019;21(1):65–77. doi:10.1684/epd.2019.1028.Google Scholar
Harvey, AS, Mandelstam, SA, Maixner, WJ, et al. The surgically remediable syndrome of epilepsy associated with bottom-of-sulcus dysplasia. Neurology. 2015;84(20):2021–2028. doi:10.1212/WNL.0000000000001591.Google Scholar
Antel, SB, Bernasconi, A, Bernasconi, N, et al. Computational models of MRI characteristics of focal cortical dysplasia improve lesion detection. Neuroimage. 2002;17(4):1755–1760. doi:10.1006/nimg.2002.1312.Google Scholar
Antel, SB, Collins, DL, Bernasconi, N, et al. Automated detection of focal cortical dysplasia lesions using computational models of their MRI characteristics and texture analysis. Neuroimage. 2003;19(4): 1748–1759. doi:10.1016/S1053-8119(03)00226-X.Google Scholar
Hong, SJ, Kim, H, Schrader, D, Bernasconi, N, Bernhardt, BC, Bernasconi, A. Automated detection of cortical dysplasia type II in MRI-negative epilepsy. Neurology. 2014;83(1):48–55. doi:10.1212/WNL.0000000000000543.Google Scholar
Jin, B, Krishnan, B, Adler, S, et al. Automated detection of focal cortical dysplasia type II with surface-based magnetic resonance imaging postprocessing and machine learning. Epilepsia. 2018;59(5):982–992. doi:10.1111/epi.14064.Google Scholar
Mo, JJ, Zhang, JG, Li, WL, et al. Clinical value of machine learning in the automated detection of focal cortical dysplasia using quantitative multimodal surface-based features. Front Neurosci. 2019;13(Jan.):1–11. doi:10.3389/fnins.2018.01008.Google Scholar
Wu, ST, Voltoline, R, Loos, W, et al. Toward a multimodal diagnostic exploratory visualization of focal cortical dysplasia. IEEE Comput Graph Appl. 2018;38(3):73–89. doi:10.1109/MCG.2018.032421655.Google Scholar
Heers, M, Rampp, S, Stefan, H, et al. MEG-based identification of the epileptogenic zone in occult peri-insular epilepsy. Seizure. 2012;21(2):128–133. doi:10.1016/j.seizure.2011.10.005.CrossRefGoogle ScholarPubMed
Ma, D, Gulani, V, Seiberlich, N, et al. Magnetic resonance fingerprinting. Nature. 2013;495(7440):187–192. doi:10.1038/nature11971.Google Scholar
Ma, D, Jones, SE, Deshmane, A, et al. Development of high-resolution 3D MR fingerprinting for detection and characterization of epileptic lesions. J Magn Reson Imaging. 2019;49(5):1333–1346. doi:10.1002/jmri.26319.Google Scholar
De Ciantis, A, Barba, C, Tassi, L, et al. 7T MRI in focal epilepsy with unrevealing conventional field strength imaging. Epilepsia. 2016;57(3):445–454. doi:10.1111/epi.13313.Google Scholar
Feldman, RE, Delman, BN, Pawha, PS, et al. 7T MRI in epilepsy patients with previously normal clinical MRI exams compared against healthy controls. PLoS One. 2019;14(3):1–24. doi:10.1371/journal.pone.0213642.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×