Based on the above detailed observations is it possible to add an ‘insular’ category to the list of epileptogenic zones that can be used as one of the dimensions of a patient-oriented epilepsy classification? In other words, is there any sequence of symptoms that are specific enough to locate the epileptogenic area in the insula and to predict that the removal of the insular cortex is necessary to make the patient seizure free? Even though SEEG-documented seizures are scarce an affirmative answer can be given to this question when, during spontaneous seizures, the patient experiences in full consciousness a symptomatic sequence made of a pharyngeal and/or laryngeal discomfort with thoracic oppression or dyspnea, unpleasant paresthesiae, warmth or pain sensation in the perioral region or spreading to a large somatic territory, followed by dysarthric or dysphonic speech and ending in focal somato-motor manifestations. Knowing that in patients illustrated in Figure 39.1, most of the antero superior quadrant of the insula has not been explored (see Figure 39.3), two variants can be distinguished according to whether the insular discharge originates from the anterior or posterior part of the insula. In rostral insular seizures viscero-motor and laryngeal symptoms are predominant (green frame in Figure 39.1), while in caudal insular seizures the ictal symptomatology is dominated by somato-sensory symptoms, which are all the more so specific that they affect a large, eventually bilateral, territory and manifest as a warm or painful sensation (red frame in Figure 39.1)! Thus most of the insular seizures can be described as a combination of vegetative and somatosensory auras according to the semiological seizure classification proposed by Lüders et al.