This case demonstrates the use of ictal SPECT as an objective way to localize surface-EEG–negative insular seizures.

A 43-year-old woman presented with events characterized by a “funny” feeling in the head, nausea, and right-hand numbness/cramping. Events lasted minutes, without impaired awareness. Onset occurred 1.5 years after an embolic left middle cerebral artery stroke. MRI showed left temporoparietal and insular T2 changes.