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Navigating the Island of Reil: how to understand the insular cortex
  1. Ray Wynford-Thomas,
  2. Rob Powell
  1. Department of Neurology, Morriston Hospital, Swansea, UK
  1. Correspondence to Dr Ray Wynford-Thomas, Department of Neurology, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; wynford-thomasra{at}


Insular-onset seizures are rare and easily misdiagnosed. In this article, we aim to highlight the often distinctive semiology of seizures involving the insula with reference to three cases. We suggest three points to aid the recognition of seizures involving the insula: (1) Seizures originating in the insula frequently present with a sensation of laryngeal constriction, dyspnoea or unpleasant somatosensory symptoms; (2) Seizures involving the anterior insula may have a silent onset, but tend to propagate rapidly to motor areas causing motor or hypermotor symptoms; (3) Seizures involving the posterior insula cause somatosensory symptoms, which are normally contralateral to the seizure onset.

  • Clinical Neurology
  • Electrical Stimulation
  • Epilepsy
  • Sleep Apnoea

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  • Contributors RW-T is the lead author and main contributor. RP has equally contributed to the manuscript and has read and approved it. Both authors agree to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Mark Manford, Cambridge, UK, and the second referee was Tim Wehner, London, UK.

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  • Editors' commentary
    Phil E M Smith Geraint N Fuller

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