PMC:6610377 / 4319-7228 JSONTXT

{"project":"MyTest","denotations":[{"id":"30838920-28314446-28639257","span":{"begin":316,"end":318},"obj":"28314446"},{"id":"30838920-15329073-28639258","span":{"begin":758,"end":760},"obj":"15329073"},{"id":"30838920-21097547-28639259","span":{"begin":1254,"end":1255},"obj":"21097547"},{"id":"30838920-23027095-28639259","span":{"begin":1254,"end":1255},"obj":"23027095"},{"id":"30838920-29389774-28639259","span":{"begin":1254,"end":1255},"obj":"29389774"},{"id":"30838920-16650142-28639260","span":{"begin":1328,"end":1331},"obj":"16650142"},{"id":"30838920-24508402-28639261","span":{"begin":1362,"end":1365},"obj":"24508402"},{"id":"30838920-25589668-28639262","span":{"begin":2393,"end":2396},"obj":"25589668"},{"id":"30838920-21097547-28639263","span":{"begin":2414,"end":2416},"obj":"21097547"},{"id":"30838920-21097547-28639264","span":{"begin":2719,"end":2720},"obj":"21097547"},{"id":"30838920-26892245-28639265","span":{"begin":2721,"end":2724},"obj":"26892245"}],"namespaces":[{"prefix":"_base","uri":"https://www.uniprot.org/uniprot/testbase"},{"prefix":"UniProtKB","uri":"https://www.uniprot.org/uniprot/"},{"prefix":"uniprot","uri":"https://www.uniprot.org/uniprotkb/"}],"text":"Clinical Semiology of Insular Seizures\nBarbara Jobst, MD, PhD, and Phillipe Kahane, MD, PhD\nThe insula is a multiconnected brain region that receives and sends information to frontal, temporal, and posterior cortical structures, which explains its strong involvement in cognitive, behavioral, and sensory processing.4 As such, seizure semiology of insular lobe seizures is far from being homogeneous, and a number of subjective and objective ictal clinical signs have been reported, including viscerosensory, somatosensory, olfactory, gustatory, and auditory auras; autonomic symptoms (vomiting, piloerection, heart rate changes); automotor and hypermotor behaviors; tonic and/or clonic motor manifestations; and language disturbances.5\nIn 2004, Isnard et al6 elegantly brought attention to a clinical pattern highly suggestive of insular lobe seizures, which included laryngeal constriction, perioral unpleasant paresthesias, lateralized somatosensory sensations, dysarthria, and focal somatomotor signs. Further intracranial electroencephalogram (EEG) studies demonstrated that besides this “perisylvian” clinical pattern, insular seizures could also manifest with “temporal-like” symptoms (altered awareness with oroalimentary and manual automatisms),7-9 “frontal-like” symptoms (hyperkinetic behaviors or tonic motor signs),10 and even with epileptic spasms,11 therefore supporting the idea that insular epilepsy is a great mimicker, depending on the pattern of seizure spread (Figure 2).\nFigure 2. Various spread patterns of insula seizures to symptomatogenic zones. Peri-S indicates perisylvian. Patients with insular epilepsy often undergo a long “odyssey” searching for help for their drug-resistant seizures until finally a diagnosis of insular epilepsy is made. Seizures can be misidentified as psychogenic nonepilepsy seizures for a lack of clear EEG correlates or misidentified as seizures originating in the frontal or temporal lobes. Patients may even have undergone previous unsuccessful epilepsy surgery until insular epilepsy is identified. Therefore, a careful analysis of seizure history, especially addressing patient-reported auras, is essential.\nAs insular seizures frequently begin with preserved awareness, a clear description of the aura may yield important information that points to an insular onset. A feeling of suffocation and breathlessness, painful sensations,12 or gustatory auras7 are highly suggestive of an insular or insulo-opercular ictal origin. Interestingly, and possibly because the insula is a multimodal area involved in the processing of various sensory stimuli, insulo-opercular seizures may also manifest as eating-, audiogenic-, and somatosensory-evoked reflex seizures.7,13 Additionally, ecstatic seizures, which have been proposed to involve the anterior insular cortex, can be triggered by thinking about specific memories or a pleasant emotional context.14"}

{"project":"0_colil","denotations":[{"id":"30838920-28314446-1108","span":{"begin":316,"end":317},"obj":"28314446"},{"id":"30838920-15329073-1109","span":{"begin":758,"end":759},"obj":"15329073"},{"id":"30838920-16650142-1111","span":{"begin":1328,"end":1330},"obj":"16650142"},{"id":"30838920-24508402-1112","span":{"begin":1362,"end":1364},"obj":"24508402"},{"id":"30838920-25589668-1113","span":{"begin":2393,"end":2395},"obj":"25589668"},{"id":"30838920-21097547-1114","span":{"begin":2414,"end":2415},"obj":"21097547"},{"id":"30838920-21097547-1115","span":{"begin":2719,"end":2720},"obj":"21097547"},{"id":"30838920-26892245-1116","span":{"begin":2721,"end":2723},"obj":"26892245"},{"id":"30838920-26924970-1117","span":{"begin":2907,"end":2909},"obj":"26924970"},{"id":"30838920-21097547-1110","span":{"begin":1254,"end":1255},"obj":"21097547"},{"id":"30838920-23027095-1110","span":{"begin":1254,"end":1255},"obj":"23027095"},{"id":"30838920-29389774-1110","span":{"begin":1254,"end":1255},"obj":"29389774"}],"text":"Clinical Semiology of Insular Seizures\nBarbara Jobst, MD, PhD, and Phillipe Kahane, MD, PhD\nThe insula is a multiconnected brain region that receives and sends information to frontal, temporal, and posterior cortical structures, which explains its strong involvement in cognitive, behavioral, and sensory processing.4 As such, seizure semiology of insular lobe seizures is far from being homogeneous, and a number of subjective and objective ictal clinical signs have been reported, including viscerosensory, somatosensory, olfactory, gustatory, and auditory auras; autonomic symptoms (vomiting, piloerection, heart rate changes); automotor and hypermotor behaviors; tonic and/or clonic motor manifestations; and language disturbances.5\nIn 2004, Isnard et al6 elegantly brought attention to a clinical pattern highly suggestive of insular lobe seizures, which included laryngeal constriction, perioral unpleasant paresthesias, lateralized somatosensory sensations, dysarthria, and focal somatomotor signs. Further intracranial electroencephalogram (EEG) studies demonstrated that besides this “perisylvian” clinical pattern, insular seizures could also manifest with “temporal-like” symptoms (altered awareness with oroalimentary and manual automatisms),7-9 “frontal-like” symptoms (hyperkinetic behaviors or tonic motor signs),10 and even with epileptic spasms,11 therefore supporting the idea that insular epilepsy is a great mimicker, depending on the pattern of seizure spread (Figure 2).\nFigure 2. Various spread patterns of insula seizures to symptomatogenic zones. Peri-S indicates perisylvian. Patients with insular epilepsy often undergo a long “odyssey” searching for help for their drug-resistant seizures until finally a diagnosis of insular epilepsy is made. Seizures can be misidentified as psychogenic nonepilepsy seizures for a lack of clear EEG correlates or misidentified as seizures originating in the frontal or temporal lobes. Patients may even have undergone previous unsuccessful epilepsy surgery until insular epilepsy is identified. Therefore, a careful analysis of seizure history, especially addressing patient-reported auras, is essential.\nAs insular seizures frequently begin with preserved awareness, a clear description of the aura may yield important information that points to an insular onset. A feeling of suffocation and breathlessness, painful sensations,12 or gustatory auras7 are highly suggestive of an insular or insulo-opercular ictal origin. Interestingly, and possibly because the insula is a multimodal area involved in the processing of various sensory stimuli, insulo-opercular seizures may also manifest as eating-, audiogenic-, and somatosensory-evoked reflex seizures.7,13 Additionally, ecstatic seizures, which have been proposed to involve the anterior insular cortex, can be triggered by thinking about specific memories or a pleasant emotional context.14"}

{"project":"2_test","denotations":[{"id":"30838920-28314446-28639257","span":{"begin":316,"end":317},"obj":"28314446"},{"id":"30838920-15329073-28639258","span":{"begin":758,"end":759},"obj":"15329073"},{"id":"30838920-21097547-28639259","span":{"begin":1254,"end":1255},"obj":"21097547"},{"id":"30838920-23027095-28639259","span":{"begin":1254,"end":1255},"obj":"23027095"},{"id":"30838920-29389774-28639259","span":{"begin":1254,"end":1255},"obj":"29389774"},{"id":"30838920-16650142-28639260","span":{"begin":1328,"end":1330},"obj":"16650142"},{"id":"30838920-24508402-28639261","span":{"begin":1362,"end":1364},"obj":"24508402"},{"id":"30838920-25589668-28639262","span":{"begin":2393,"end":2395},"obj":"25589668"},{"id":"30838920-21097547-28639263","span":{"begin":2414,"end":2415},"obj":"21097547"},{"id":"30838920-21097547-28639264","span":{"begin":2719,"end":2720},"obj":"21097547"},{"id":"30838920-26892245-28639265","span":{"begin":2721,"end":2723},"obj":"26892245"},{"id":"30838920-26924970-28639266","span":{"begin":2907,"end":2909},"obj":"26924970"}],"text":"Clinical Semiology of Insular Seizures\nBarbara Jobst, MD, PhD, and Phillipe Kahane, MD, PhD\nThe insula is a multiconnected brain region that receives and sends information to frontal, temporal, and posterior cortical structures, which explains its strong involvement in cognitive, behavioral, and sensory processing.4 As such, seizure semiology of insular lobe seizures is far from being homogeneous, and a number of subjective and objective ictal clinical signs have been reported, including viscerosensory, somatosensory, olfactory, gustatory, and auditory auras; autonomic symptoms (vomiting, piloerection, heart rate changes); automotor and hypermotor behaviors; tonic and/or clonic motor manifestations; and language disturbances.5\nIn 2004, Isnard et al6 elegantly brought attention to a clinical pattern highly suggestive of insular lobe seizures, which included laryngeal constriction, perioral unpleasant paresthesias, lateralized somatosensory sensations, dysarthria, and focal somatomotor signs. Further intracranial electroencephalogram (EEG) studies demonstrated that besides this “perisylvian” clinical pattern, insular seizures could also manifest with “temporal-like” symptoms (altered awareness with oroalimentary and manual automatisms),7-9 “frontal-like” symptoms (hyperkinetic behaviors or tonic motor signs),10 and even with epileptic spasms,11 therefore supporting the idea that insular epilepsy is a great mimicker, depending on the pattern of seizure spread (Figure 2).\nFigure 2. Various spread patterns of insula seizures to symptomatogenic zones. Peri-S indicates perisylvian. Patients with insular epilepsy often undergo a long “odyssey” searching for help for their drug-resistant seizures until finally a diagnosis of insular epilepsy is made. Seizures can be misidentified as psychogenic nonepilepsy seizures for a lack of clear EEG correlates or misidentified as seizures originating in the frontal or temporal lobes. Patients may even have undergone previous unsuccessful epilepsy surgery until insular epilepsy is identified. Therefore, a careful analysis of seizure history, especially addressing patient-reported auras, is essential.\nAs insular seizures frequently begin with preserved awareness, a clear description of the aura may yield important information that points to an insular onset. A feeling of suffocation and breathlessness, painful sensations,12 or gustatory auras7 are highly suggestive of an insular or insulo-opercular ictal origin. Interestingly, and possibly because the insula is a multimodal area involved in the processing of various sensory stimuli, insulo-opercular seizures may also manifest as eating-, audiogenic-, and somatosensory-evoked reflex seizures.7,13 Additionally, ecstatic seizures, which have been proposed to involve the anterior insular cortex, can be triggered by thinking about specific memories or a pleasant emotional context.14"}

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Further intracranial electroencephalogram (EEG) studies demonstrated that besides this “perisylvian” clinical pattern, insular seizures could also manifest with “temporal-like” symptoms (altered awareness with oroalimentary and manual automatisms),7-9 “frontal-like” symptoms (hyperkinetic behaviors or tonic motor signs),10 and even with epileptic spasms,11 therefore supporting the idea that insular epilepsy is a great mimicker, depending on the pattern of seizure spread (Figure 2).\nFigure 2. Various spread patterns of insula seizures to symptomatogenic zones. Peri-S indicates perisylvian. Patients with insular epilepsy often undergo a long “odyssey” searching for help for their drug-resistant seizures until finally a diagnosis of insular epilepsy is made. Seizures can be misidentified as psychogenic nonepilepsy seizures for a lack of clear EEG correlates or misidentified as seizures originating in the frontal or temporal lobes. Patients may even have undergone previous unsuccessful epilepsy surgery until insular epilepsy is identified. Therefore, a careful analysis of seizure history, especially addressing patient-reported auras, is essential.\nAs insular seizures frequently begin with preserved awareness, a clear description of the aura may yield important information that points to an insular onset. A feeling of suffocation and breathlessness, painful sensations,12 or gustatory auras7 are highly suggestive of an insular or insulo-opercular ictal origin. Interestingly, and possibly because the insula is a multimodal area involved in the processing of various sensory stimuli, insulo-opercular seizures may also manifest as eating-, audiogenic-, and somatosensory-evoked reflex seizures.7,13 Additionally, ecstatic seizures, which have been proposed to involve the anterior insular cortex, can be triggered by thinking about specific memories or a pleasant emotional context.14"}