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Cerebral Cortex, Vol. 12, No. 4, 376-385, April 2002
© 2002 Oxford University Press

Representation of Pain and Somatic Sensation in the Human Insula: a Study of Responses to Direct Electrical Cortical Stimulation

Karine Ostrowsky, Michel Magnin1, Philippe Ryvlin, Jean Isnard, Marc Guenot2 and François Mauguière

1 EA 1880-IFR 19, Hôpital Neurologique, Bâtiment B13, and , 2 Hôpital Neurologique, Service de Neurochirurgie A, 59 Bd Pinel, 69003 Lyon, France , Hôpital Neurologique, Service d'Exploration Fonctionnelle Neurologique et d'Epileptologie, 59 Bd Pinel, 69003 Lyon, France

François Mauguière, Hôpital neuro-logique Pierre Wertheimer, Service de Neurologie Fonctionnelle et d'Epileptologie, 59 Boulevard Pinel, 69394 Lyon cedex 03, France. Email: mauguier{at}univ-lyon1.fr.

We studied painful and non-painful somaesthetic sensations elicited by direct electrical stimulations of the insular cortex performed in 43 patients with drug refractory temporal lobe epilepsy, using stereotactically implanted depth electrodes. Painful sensations were evoked in the upper posterior part of the insular cortex in 14 patients, mostly in the right hemisphere. Non-painful sensations were elicited in the posterior part of the insular cortex in 16 patients, in both hemispheres. Thus, painful and non-painful somaesthetic representa-tions in the human insula overlap. Both types of responses showed a trend toward a somatotopic organization. These results agree with previous anatomical and unit recording studies in monkeys indicating a participation of the posterior part of the insular cortex in processing both noxious and innocuous somaesthetic stimuli. In humans, both a posterior and an anterior pain-related cortical area have been described within the insular cortex using functional imaging. Our results help to define the respective functional roles of these two insular areas. Finally, lateralization in the right hemisphere of sites where painful sensations were evoked is coherent with the hypothesis of a preponderant role of this hemisphere in species survival.


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