John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the International League Against Epilepsy

The insula lobe and sudden unexpected death in epilepsy: a hypothesis Volume 19, numéro 1, March 2017


(1) In general, which two factors are deemed to be direct causes of SUDEP?


(2) How does the insula lobe function as a nerve centre of the brain, anatomically?


(3) The insula lobe performs multiple physiological functions, which role does it play in relation to SUDEP?




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(1) Sudden cardiac arrest and respiratory apnoea are generally considered to be two direct causes of SUDEP.

(2) The insula lobe is an integral part of the limbic system, both structurally and functionally. Anatomically, the insula lobe is deeply located in the cerebral cortex, within the lateral fissure, under frontal lobe, in the front of parietal lobe, and on the inner side of the temporal lobe. The insula lobe connects to the frontal, temporal, and pillow area and limbic and paralimbic systems through the superior longitudinal fasciculus, hook-like fasciculus, fronto-occipital fasciculus, and anterior commissure, respectively. Thus, the insula lobe serves as a virtual nerve centre of the brain owing to its complex interlinkage with the surrounding cortex, autonomic nervous system, as well as with the limbic system.

(3) Anatomical and functional evidence suggests that the insular lobe is an important cortical region that modulates functioning of the autonomic nervous system and plays a role in regulating respiratory and cardiac function which are the main causes of SUDEP.


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