The Insula: A Stimulating Island of the Brain

Direct cortical stimulation (DCS) in epilepsy surgery patients has a long history of functional brain mapping and seizure triggering. Here, we review its findings when applied to the insula in order to map the insular functions, evaluate its local and distant connections, and trigger seizures. Clini...

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Autores principales:	Inès Rachidi, Lorella Minotti, Guillaume Martin, Dominique Hoffmann, Julien Bastin, Olivier David, Philippe Kahane
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	insula epilepsy SEEG direct cortical stimulation cortico-cortical-evoked potentials Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/c9af8fa96b874e68b669cb59d49e7cd1
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spelling	oai:doaj.org-article:c9af8fa96b874e68b669cb59d49e7cd12021-11-25T16:59:13ZThe Insula: A Stimulating Island of the Brain10.3390/brainsci111115332076-3425https://doaj.org/article/c9af8fa96b874e68b669cb59d49e7cd12021-11-01T00:00:00Zhttps://www.mdpi.com/2076-3425/11/11/1533https://doaj.org/toc/2076-3425Direct cortical stimulation (DCS) in epilepsy surgery patients has a long history of functional brain mapping and seizure triggering. Here, we review its findings when applied to the insula in order to map the insular functions, evaluate its local and distant connections, and trigger seizures. Clinical responses to insular DCS are frequent and diverse, showing a partial segregation with spatial overlap, including a posterior somatosensory, auditory, and vestibular part, a central olfactory-gustatory region, and an anterior visceral and cognitive-emotional portion. The study of cortico-cortical evoked potentials (CCEPs) has shown that the anterior (resp. posterior) insula has a higher connectivity rate with itself than with the posterior (resp. anterior) insula, and that both the anterior and posterior insula are closely connected, notably between the homologous insular subdivisions. All insular gyri show extensive and complex ipsilateral and contralateral extra-insular connections, more anteriorly for the anterior insula and more posteriorly for the posterior insula. As a rule, CCEPs propagate first and with a higher probability around the insular DCS site, then to the homologous region, and later to more distal regions with fast cortico-cortical axonal conduction delays. Seizures elicited by insular DCS have rarely been specifically studied, but their rate does not seem to differ from those of other DCS studies. They are mainly provoked from the insular seizure onset zone but can also be triggered by stimulating intra- and extra-insular early propagation zones. Overall, in line with the neuroimaging studies, insular DCS studies converge on the view that the insula is a multimodal functional hub with a fast propagation of information, whose organization helps understand where insular seizures start and how they propagate.Inès RachidiLorella MinottiGuillaume MartinDominique HoffmannJulien BastinOlivier DavidPhilippe KahaneMDPI AGarticleinsulaepilepsySEEGdirect cortical stimulationcortico-cortical-evoked potentialsNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENBrain Sciences, Vol 11, Iss 1533, p 1533 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	insula epilepsy SEEG direct cortical stimulation cortico-cortical-evoked potentials Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	insula epilepsy SEEG direct cortical stimulation cortico-cortical-evoked potentials Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Inès Rachidi Lorella Minotti Guillaume Martin Dominique Hoffmann Julien Bastin Olivier David Philippe Kahane The Insula: A Stimulating Island of the Brain
description	Direct cortical stimulation (DCS) in epilepsy surgery patients has a long history of functional brain mapping and seizure triggering. Here, we review its findings when applied to the insula in order to map the insular functions, evaluate its local and distant connections, and trigger seizures. Clinical responses to insular DCS are frequent and diverse, showing a partial segregation with spatial overlap, including a posterior somatosensory, auditory, and vestibular part, a central olfactory-gustatory region, and an anterior visceral and cognitive-emotional portion. The study of cortico-cortical evoked potentials (CCEPs) has shown that the anterior (resp. posterior) insula has a higher connectivity rate with itself than with the posterior (resp. anterior) insula, and that both the anterior and posterior insula are closely connected, notably between the homologous insular subdivisions. All insular gyri show extensive and complex ipsilateral and contralateral extra-insular connections, more anteriorly for the anterior insula and more posteriorly for the posterior insula. As a rule, CCEPs propagate first and with a higher probability around the insular DCS site, then to the homologous region, and later to more distal regions with fast cortico-cortical axonal conduction delays. Seizures elicited by insular DCS have rarely been specifically studied, but their rate does not seem to differ from those of other DCS studies. They are mainly provoked from the insular seizure onset zone but can also be triggered by stimulating intra- and extra-insular early propagation zones. Overall, in line with the neuroimaging studies, insular DCS studies converge on the view that the insula is a multimodal functional hub with a fast propagation of information, whose organization helps understand where insular seizures start and how they propagate.
format	article
author	Inès Rachidi Lorella Minotti Guillaume Martin Dominique Hoffmann Julien Bastin Olivier David Philippe Kahane
author_facet	Inès Rachidi Lorella Minotti Guillaume Martin Dominique Hoffmann Julien Bastin Olivier David Philippe Kahane
author_sort	Inès Rachidi
title	The Insula: A Stimulating Island of the Brain
title_short	The Insula: A Stimulating Island of the Brain
title_full	The Insula: A Stimulating Island of the Brain
title_fullStr	The Insula: A Stimulating Island of the Brain
title_full_unstemmed	The Insula: A Stimulating Island of the Brain
title_sort	insula: a stimulating island of the brain
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/c9af8fa96b874e68b669cb59d49e7cd1
work_keys_str_mv	AT inesrachidi theinsulaastimulatingislandofthebrain AT lorellaminotti theinsulaastimulatingislandofthebrain AT guillaumemartin theinsulaastimulatingislandofthebrain AT dominiquehoffmann theinsulaastimulatingislandofthebrain AT julienbastin theinsulaastimulatingislandofthebrain AT olivierdavid theinsulaastimulatingislandofthebrain AT philippekahane theinsulaastimulatingislandofthebrain AT inesrachidi insulaastimulatingislandofthebrain AT lorellaminotti insulaastimulatingislandofthebrain AT guillaumemartin insulaastimulatingislandofthebrain AT dominiquehoffmann insulaastimulatingislandofthebrain AT julienbastin insulaastimulatingislandofthebrain AT olivierdavid insulaastimulatingislandofthebrain AT philippekahane insulaastimulatingislandofthebrain
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The Insula: A Stimulating Island of the Brain

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