The anatomic substrate of the epigastric aura - a case report

Epigastric sensations are the most frequent type of aura in medial temporal lobe epilepsy. Until now, the site of the symptomatogenic zone of the epig astric aura remains controversial. The temporal lobe has been discussed, as well as the insular cortex. The case presented here supports the assumptio n of an insular origin of the epigastric aura. A 44-year-old male suffered from typical psychomotor seizures preceded by a n epigastric aura. Imaging revealed a cavernoma located in the right insula r region,the ipsilateral temporal lobe being otherwise unremarkable. The le sion was surgically removed, leaving the temporal lobe untouched. Apart fro m one clinical episode that was unlike his habitual seizures, the patient r emained free of seizures (including auras). We conclude that the insular co rtex was most likely the symptomatogenic zone for this patient's epigastric auras. Although it can not be excluded that this patient's aura resulted f rom ictal activation of other brain structures, the successful lesionectomy is in favor of our hypothesis.