Abstract

The insular cortex (IC) is considered a rich hub for context-sensitive emotions/social cognition. Patients with focal IC stroke provide unique opportunities to study socio-emotional processes. Nevertheless, Couto et al. (20130) have recently reported controversial results regarding IC involvement in emotion and social cognition. Similarly, patients with similar lesions show high functional variability, ranging from almost totally preserved to strongly impaired behavior. Critical evidence suggests that the variability of these patients in the above domains can be explained by enhanced neuroplasticity, compensatory processes, and functional remapping after stroke. Therefore, socio-emotional processes would depend on long-distance connections between the IC and frontotemporal regions. We propose that predictive coding and effective connectivity represent a novel approach to explore functional connectivity and assess compensatory, contralateral, and subsidiary network differences among focal stroke patients. This approach would help explain why socio-emotional performance is so variable within this population.