Understanding the semiology of epileptic seizures is pivotal for diagnosing epilepsy accurately. However, diagnosing insular epilepsy poses a challenge due to its multifaceted functions and extensive connections. Its semiology can be misconstrued, leading to misinterpretation and mislocation within adjacent frontal, temporal, or parietal lobes, potentially resulting in ineffective treatment or surgical outcomes. Insular epileptic seizures, though rare, are likely underdiagnosed. These seizures may preserve consciousness but manifest with subjective symptoms and emotions often imperceptible to observers, suggesting a potential underestimation of their prevalence. This review aims to elucidate the multimodal role of the insular cortex and its correlation with the semiology of epileptic seizures. Understanding the insular cortex’s involvement in both initiating and propagating epileptic activity, as well as its dynamic interaction with other brain areas during seizures, is crucial[1]. Considering the connectivity ofthe insular cortex couldenhance patient management and prognosis, providing valuable insights for clinicians.