Background Insular epilepsy is an uncommon and frequently overlooked condition, causing a rare type of seizures which is still not included by The International League Against epilepsy (ILAE) in its current classification for epileptic seizures, epilepsy or epileptic syndromes.
Case Presentation A 25-year-old woman presented with new onset secondary generalised seizures. Her seizures began with speech arrest, hypersalivation followed by painful sensation in the throat and automatic chewing movements. Despite the generalised seizures being controlled with antiepileptic treatment, she continued to have 10–30 complex partial seizures a day. She eventually developed auditory hallucinations and retrograde amnesia. She had normal blood tests and CSF examination. However, her EEG revealed slow wave activity over the left mid temporal region (Abstract POE03 Figure 1) and her MRI brain revealed abnormal high signal changes in the left insular region (Abstract POE03 Figure 2) followed by similar changes in the right side (Abstract POE03 Figure 3). These changes resolved subsequently (Abstract POE03 Figure 4). Currently she experiences one minor seizure every 1–2 months. Her auditory hallucination resolved but she continues to suffer from retrograde amnesia for one year of her life prior to her illness.
Conclusion The initial MRI brain changes and the EEG finding in our case correlate with insular seizures. The MRI changes in the right lobe suggest functional kindling as a result of repeated seizures in the left lobe.
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