Insular epilepsy is a great mimicker and can be mistaken for seizures originating from other areas of the brain or as nonepileptic spells. The semiology of insular epilepsy can include, but is not limited to, auditory illusions, paresthesias, gastric rising, laryngeal constriction, and hyperkinetic movements. These arise from both the functions of the insula itself and its extensive connections with other regions of the brain. Noninvasive workup can be negative or nonlocalizing because of the insula's location deep within the lateral sulcus. Stereotactic EEG can therefore be an important tool in cases of insular epilepsy so that patients may be appropriately diagnosed and evaluated for potential surgical treatment. Li et al. present 2 cases of epilepsy with nonlocalizing scalp EEG and challenging semiologies, the workup undertaken to identify them as cases of insular epilepsy, and subsequent surgical treatments and outcomes. See article link in bio. Pearls Insular seizures are among the great mimickers and can be mistaken for seizures originating from other regions of the brain, which can make diagnosis challenging. The importance of correctly diagnosing insular epilepsy lies in the opportunity for surgical treatment because any epilepsy that becomes drug-resistant should undergo surgical evaluation. Oy-sters In rare cases, insular epilepsy can be mistaken for nonepileptic spells. Cases of negative or nonlocalizing scalp EEG with a history of stereotyped events should raise concern for epileptic seizures arising from deep cortical foci. Figure 1 Scalp EEG and Stereotactic EEG (SEEG) Evaluation in Case 1 #Epilepsy #Seizure #Neurology #Neurologist #Neuroscience #Neuro #NeurologyRF #NeurologyResident #Neuro #MedEd #MedStudent #MedicalStudent #MedSchool