Hyperkinetic Seizures in Insular and Insulo-Opercular Seizure Onset: A Systematic Review.

In 30 seconds

This systematic review examined hyperkinetic seizures (HKS) in people with pure insular or insulo-opercular seizure onset, using reports and retrospective series with invasive recording and postsurgical outcome criteria. Fourteen studies comprising 34 patients were included; 61.8% had pure insular onset, and focal cortical dysplasia was the most common etiology, reported in two-thirds. Most seizures began with non-motor features (76.5%). Pure insular onset was associated with more integrated/natural hyperkinetic behaviors, agitation, vocalization, and breathing difficulties than insulo-opercular onset. The authors consider these findings exploratory.

Key findings

• Across 14 studies and 34 patients, 61.8% had pure insular seizure onset.
• Focal cortical dysplasia was the most common etiology, present in two-thirds of cases.
• Most HKS began with non-motor semiology (76.5%).
• Pure insular onset was associated with more type 3 hyperkinetic automatisms and with agitation, vocalization, and breathing difficulties (p < 0.05).

Why it matters

The review highlights that HKS can occur with insular as well as insulo-opercular seizure onset, and that associated behaviors may differ by onset location. Recognising non-motor beginnings and the range of hyperkinetic features may help clinicians consider these seizure patterns when interpreting semiology. The small, heterogeneous evidence base means these patterns should inform assessment cautiously rather than be treated as definitive.

What to keep in mind

The evidence came from only 14 studies and 34 patients, with heterogeneous reports and retrospective series; the authors describe the findings as exploratory.