Increased Socio-Emotional Deficits Following Epilepsy Surgical Procedures Involving the Insula
Abstract number :
2.45
Submission category :
9. Surgery / 9A. Adult
Year :
2025
Submission ID :
1362
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Viraj Shivadevuni, Undergraduate – Emory University School of Medicine
Fareed Ahamad, BS – Emory University School of Medicine
Adam Dickey, MD, PhD – Baylor College of Medicine
Edward Valentin, PhD – Emory University School of Medicine
Taylor Shade, BS – Emory University School of Medicine
Evan Brady, BS – Emory University School of Medicine
Lydia Swinehart, BS – Emory University School of Medicine
Ammar Kheder, MD, MRCP – Michigan State University
Nigel Pedersen, MD – University of California Davis
Nealen Laxpati, MD, PhD – Emory University School of Medicine
Robert Gross, MD, PhD – Robert Wood Johnson School of Medicine
Stephan Hamman, PhD – Emory University School of Medicine
Daniel Drane, PhD – Emory University School of Medicine
Rationale: Cognitive functions have been frequently studied in the context of epilepsy surgery, but little attention has been paid to socio-emotional function. As socio-emotional changes have been more recently associated with insular damage in other patient populations (stroke), we hypothesized that such changes may be prevalent in epilepsy surgeries involving this structure.
Methods: We explored socio-emotional behavioral changes in a subset of epilepsy patients (n=15) undergoing surgeries involving the insular cortex on several relevant variables (e.g., emotional lability, loss of self-control, alterations in emotion recognition). Data were obtained from neuropsychological (NP) testing and medical records to assess changes in socio-emotional function and psychopathology. All patients had undergone standard epilepsy surgery work-up (including stereo-electroencephalography). Surgical procedures included either laser interstitial thermal therapy ablations or open resections of some portion of the left (n=6) or right (n=9) insula. In some cases, patients had already undergone a surgical procedure before the insula procedure, but did not experience behavioral change until after the insular destruction. We used an exact binomial test to determine if post-surgical behavioral change exceeded a hypothesized rate of 50%, although clinical lore suggests no behavioral change with insular surgery. We report socio-emotional change by procedural laterality without statistical comparison due to limited power.
Results: Behavioral changes were observed on at least one test in all patients after right or left insula surgeries, which is significantly greater than an assumed base rate of 50% (p< .0001). However, there do appear to be differences related to the side of surgery. Right insular procedures tended to restrict or suppress emotion, disrupt self-control (right=6/9, left=1/6), and lead to thought disorder (e.g., psychosis) rather than disturbance of mood/anxiety. Emotional lability and irritability commonly occurred following either insular surgery. In contrast, left insular destruction may lead to worsening mental health status (left=4/6, right=2/9) and decreased ability to recognize emotions in others. See Table 1 for proportions of behaviors by laterality.
Surgery