Neuropsychological performance before and after partial or complete insulectomy in patients with epilepsy.

Resection of the insular cortex is becoming more frequent as it is increasingly recognized that a nonnegligible proportion of surgical candidates with drug-resistant epilepsy have an epileptogenic zone that involves the insula. In the last decades, however, the insula has been proposed to be involved in several neuropsychological functions, and there is a lack of documentation on whether partial or complete insulectomy results in permanent cognitive impairments in this clinical population. In this study, we conducted standard preoperative and postoperative neuropsychological assessments in 18 patients undergoing epilepsy surgery that included the removal of the insula in the right (n=13) or the left (n=5) hemisphere. Postoperative testing was conducted at least five months after surgery. Cognitive impairments were common and heterogeneous prior to surgery, with language and verbal memory impairments being especially frequent among patients in whom epileptic seizures originated from the left hemisphere. After surgery, declines and improvements occurred on a variety of outcomes, although new deficits were relatively infrequent among patients who had obtained normal performance at baseline. Statistical comparisons between preoperative and postoperative assessments revealed significant deterioration of only one outcome - the color naming condition of the Stroop test - which relies on oro-motor speed and lexical access. These findings suggest that partial or complete resection of the insular cortex in patients with drug-refractory epilepsy can be conducted without major permanent neuropsychological impairments in a vast majority of patients. However, small decrements in specific cognitive functions can be expected, which should also be taken into account when considering the surgical option in this clinical population.

Reflex reading epilepsy: effect of linguistic characteristics on spike frequency.

Reading epilepsy is a rare reflex epilepsy in which seizures are provoked by reading. Several cases have been described in the literature, but the pathophysiological processes vary widely and remain unclear. We describe a 42-year-old male patient with reading epilepsy evaluated using clinical assessments and continuous video/EEG recordings. We administered verbal, nonverbal, and reading tasks to determine factors precipitating seizures. Linguistic characteristics of the words were manipulated. Results indicated that reading-induced seizures were significantly more numerous than those observed during verbal and nonverbal tasks. In reading tasks, spike frequency significantly increased with involvement of the phonological reading route. Spikes were recorded predominantly in left parasagittal regions. Future cerebral imaging studies will enable us to visualize the spatial localization and temporal course of reading-induced seizures and brain activity involved in reading. A better understanding of reading epilepsy is crucial for reading rehabilitation in these patients.