Rev Neurol France
-
The role of the insular lobe in temporal lobe epilepsy (TLE) has often been suggested but never directly demonstrated. In this article, we review data from recent literature and from our own stereo-electroencephalographic (SEEG) recordings in patients referred for temporal lobe epilepsy surgery. Our description of the clinical features of insular lobe seizures is based on data from video and SEEG ictal recordings and direct electric cortical stimulation in a population of 50 consecutive patients whose seizures, on the basis of scalp video EEG recordings, were suspected to originate from, or to rapidly propagate to, the perisylvian cortex. ⋯ Moreover, from the whole set of insular stimulations that we performed it could be concluded that the insular cortex is involved in somatic, vegetative and visceral functions to which spontaneous ictal insular symptoms are related. The observation of the insular symptoms sequence at the onset of seizures in patients who are candidates for TLE surgery strongly suggests that the epileptic focus is located in the insular lobe. It entails the risk of unsuccessful temporal lobectomy and should lead to reconsider the indication of temporal lobectomy and to explore directly the ictal activity of both mesiotemporal and insular cortices before making any decision regarding epilepsy surgery.
-
Due to the proximity of eloquent areas of the brain, the surgical treatment of insular lesions causing refractory epilepsy is considered difficult. We report here on our experience in this field. ⋯ In selected patients, an individually tailored lesionectomy of insular lesions can be performed, with acceptable safety, to provide a high rate of satisfactory seizure relief. Indeed, even subtotal resection can result in effective seizure control.
-
Comatose state is a major cause for admission to the intensive care unit. The most commonly used assessment score is the Glasgow coma scale (GCS). Although widely accepted, this score has several limitations. Recently, the full outline of unresponsiveness score (FOUR) has been validated and tested as reliable as the GCS. ⋯ The French version of the FOUR score has an excellent interobserver reliability. This score is easy to perform and well accepted, only requiring simple and short training.