A 30-year-old man had a long history of seizures that began with feelings of tightness in his throat and fear, followed by projectile vomiting and head and eye deviation to the left. These episodes were not completely controlled by antiepileptic medications. Video EEG monitoring confirmed his clinical description. Corticography was performed before and after temporal lobectomy and revealed residual spikes in the unresectable tissue of the insula. Three years postoperatively he has had no seizures with vomiting but has occa- sional 'auras' of throat tightening and fear. The case suggests that the insula may be a trigger area for emesis but requires anterior-me- sial temporal cortex for completion.
Bibliographical noteFunding Information:
* Dr. Mireles is the recipient Clinical Research Fellowship America. Supported in part of the John Hughings Jackson of the Epilepsy Foundation of by NIH Grant P50-NS16308.
- Complex partial seizures
- Epilepsy surgery
- Insular cortex