• Yasmine Aitouche, Steve A Gibbs, Guillaume Gilbert, Olivier Boucher, Alain Bouthillier, and Dang Khoa Nguyen.
• Department of Neurosciences, Université de Montréal, Canada.
• J Neuroimaging. 2017 Sep 1; 27 (5): 517-523.

Background And PurposeRecent studies suggest that a nonnegligible proportion of drug-resistant epilepsy surgery candidates have an epileptogenic zone that involves the insula. We aimed to examine the value of proton magnetic resonance spectroscopy (1 H-MRS) in identifying patients with insular cortex epilepsy.MethodsPatients with possible nonlesional drug-refractory insular epilepsy underwent a voxel-based 1 H-MRS study prior to an intracranial electroencephalographic (EEG) study. Patients were then divided into two groups based on invasive EEG findings: the insular group with evidence of insular seizures and the noninsular group with no evidence of insular seizures. Sixteen age-matched healthy controls were also scanned for normative data.ResultsTwenty-two epileptic patients were recruited, 12 with insular seizures and 10 with extra-insular seizures. Ipsilateral and contralateral insular N-acetyl-aspartate concentrations ([NAA]) and NAA/Cr ratios were found to be similar in both patient groups. No significant differences in [NAA] or NAA/Cr ratios were found between the insular group, noninsular group, and healthy controls. [NAA] and NAA/Cr asymmetry indices correctly lateralized the seizure focus in only 16.7% and 0% of patients, respectively.ConclusionsOur preliminary findings suggest that 1 H-MRS fares poorly in identifying patients with nonlesional insular epilepsy.Copyright © 2017 by the American Society of Neuroimaging.

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