• Thomas Blauwblomme, Olivier David, Lorella Minotti, Anne-Sophie Job, Serge Chassagnon, Dominique Hoffman, Stéphan Chabardes, and Philippe Kahane.
• Department of Pediatric Neurosurgery, APHP, Hospital Necker, Paris, France.
• Epilepsia. 2013 Sep 1; 54 (9): 1658-67.

PurposeFailure of anterior temporal lobectomy for temporal lobe epilepsy has raised the question of insular cortex involvement in these seizures. Because of difficulties in exploring the insula with invasive electroencephalography (EEG) recordings, only few studies have been performed and this question remains unanswered.MethodsHere, we studied 17 patients who underwent surgery for drug-resistant temporal lobe epilepsy, explored with intracerebral electrodes, with at least one electrode coplanar to the insula. We analyzed seizure propagation patterns from temporal lobe structures to the insula, and their effect on outcome. We used an objective measure of the epileptogenicity of the insula for individual cases and group analysis between patients who were seizure-free after surgery and the others.Key FindingsAll temporal lobe seizures propagated to the insular cortex, with a shorter propagation delay in the case of mesiolateral temporal lobe seizures, thus supporting the existence of a perilimbic network. Epileptogenicity of the insular cortex was not a prognostic factor for outcome after surgery.SignificanceInsular involvement in temporal lobe seizure is not per se a prognostic factor for surgical outcome. Prognosis may be correlated with larger epileptogenic zones that our stereoelectroencephalography spatial sampling could have underestimated.Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

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