Introduction
Barbara C. Jobst, MD, PhD, and Fred Lado, MD, PhD
This review is a report from the Epilepsy Specialist Symposium presented at the 2017 American Epilepsy Society Meeting in Washington DC. The faculty, through their amazing enthusiasm, delivered outstanding content so that nearly everyone in the room learned something new. The symposium was aimed at understanding the semiology of insular seizures, the invasive and noninvasive investigation of the insula, and surgical approaches. As the organizers, we would like to thank the faculty for their excellent contributions and for setting a high standard for future symposia.

Anatomy of the Insula
The insular lobe is a thin cortical structure located deep in the Sylvian fissure, covered by a rich vascular network and hidden by the fronto-parieto-temporal operculum. These anatomic constraints make its evaluation and surgical access difficult (Figure 1). The insula is a complex structure, with 7 cytoarchitectonic subdivisions that encompass 5 gyri1 and 4 different functional areas (cognitive, social-emotional, chemical-sensory, and sensory-motor) that overlap.2 Despite its name, the insula is not isolated.3 It is rather a highly connected brain region, and therefore seizures originating in the insula are great mimickers of seizures originating elsewhere. Insular epilepsy, although reported for a long time, is a form of epilepsy that remains difficult to recognize, evaluate, and treat surgically.
Figure 1.  A, The insula is anatomically subdivided in an anterior part that comprises 3 short gyri (a, anterior; m, middle; p, posterior) and a posterior part that comprises 2 long gyri (A, anterior; P, posterior). B, The insula is covered by the suprasylvian and infrasylvian opercular regions that are essential for motor, sensory, auditory, and language processing. Numbers refer to Brodmann’s area. CS indicates central sulcus of the insula.