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Orbitofrontal and insular epilepsy.
MedLine Citation:
PMID:  23027095     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE: : Orbitofrontal and insular epilepsy are difficult to recognize because clinical presentations are variable and surgical approaches remain difficult.
METHODS: : Literature review and review of our own case series including selected cases regarding the clinical manifestation and diagnostic utility of diagnostic tests in orbitofrontal and insular epilepsy.
RESULTS: : Orbitofrontal epilepsy presents with either frontal lobe type seizures with hypermotor automatism or temporal lobe type seizures with oroalimentary and manual automatisms depending on the spread pattern. Ictal single photon emission computed tomography (SPECT) and other functional imaging can be helpful, but intracranial electroencephalograms (EEGs) are still required to identify orbitofrontal seizure onset. Insular epilepsy presents with throat constriction and unilateral paresthesias. Preoperative functional imaging methods can be helpful, but exploration of the insula is required to identify unequivocal insular onset. Intracranial EEG in the insula can be performed safely and should be considered in atypical temporal lobe cases.
CONCLUSIONS: : Intracranial EEG remains the main diagnostic modality to identify orbitofrontal and insular epilepsy. Newer diagnostic modalities such as high-frequency oscillations, EEG, functional magnetic resonance imaging (fMRI), magnet resonance spectroscopy, and magnet source imaging need to be examined further to establish their diagnostic utility.
Authors:
Matthias F Kriegel; David W Roberts; Barbara C Jobst
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society     Volume:  29     ISSN:  1537-1603     ISO Abbreviation:  J Clin Neurophysiol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8506708     Medline TA:  J Clin Neurophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  385-91     Citation Subset:  IM    
Affiliation:
*Department of Neurology, Dartmouth Medical School, Hanover, New Hampshire, U.S.A. †Medizinische Fakultaet, Private Universitaet Witten/Herdecke, Germany ‡Section of Neurosurgery, Dartmouth Medical School, Hanover, New Hampshire, U.S.A.
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