Stimulation-based compassion mapping to assess risk of insular resection for surgical epilepsy management: illustrative case

Background: The insula is a central node in network models of compassion and empathy. Because of this, resection of the insula for the treatment of drug-resistant epilepsy can change an individual's level of compassion.

Observations: Here, the authors present the clinical case of a woman with drug-resistant epilepsy localized to the nondominant insula. Because of the widespread literature implicating insular function in empathy and compassion, including lesion studies, her primary concern was changes in her compassion level after insular resection. In this case, the authors performed a novel compassion mapping paradigm before resection, using 30-second video clips to elicit compassion. This showed no changes in compassion with electrical stimulation of sites spanning the anterior insula, providing some reassurance that resection would not affect her compassion. Consistent with this, pre- and postresection testing, along with informal subjective reports by the patient, demonstrated no change in compassion or subcomponents of compassion (sadness and empathy) after right insular resection.

Lessons: While resection of the nondominant insular cortex warrants caution, this case illustrates a compassion mapping paradigm that reassured the clinical team and the patient that her compassion would not be affected and formal postoperative testing that was consistent with this. https://thejns.org/doi/10.3171/CASE24339.