Insular epilepsy, an under-recognized seizure semiology: A review for general neurologist

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Figure 1
Insular cortex anatomy
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Figure 2
The afferent and efferent connection of insular cortex, this figure is adopted with permission and modification from Augustine et al 1996 (16)

TABLE 1

Insular versus temporal versus frontal ictal clinical features.

Clinical features	Insular	Temporal	Frontal
Painful somatosensory	Common	No	No
Throat sensation	Common	Rare	No
Laryngeal constriction	Common	Rare	No
Hyper-motor	Yes	No	common
Orofacial sensation	Common	Rare	No
Viscerovegetative signs, including hypersalivation, nausea, facial blush, sweaty hands and urge to urinate	Common	Rare	No
Speech arrest/dysarthria	Yes (dominant side)	Yes (dominant side)	Yes (dominant side)
Epigastric rising sensation	Rare	Yes	No
Altered awareness and loss of consciousness	No	Yes	Brief