Association Between Semiology and Anatomo-functional Localization in Patients With Cingulate Epilepsy

Abstract

Background and Objectives:Cingulate epilepsy (CE) is a rare and challenging type of focal epilepsy, due to the polymorphic semiology of the seizures, mimicking other types of epilepsy, and the limited utility of scalp-EEG.Methods:We selected consecutive drug-resistant subjects with CE who were seizure-free after surgery, with seizure onset zone (SOZ) confirmed in the CC (cingulate cortex) by histology and/or SEEG. We analysed subjective and objective ictal manifestations using video recordings and correlated semeiology with anatomical CC subregions (anterior, anterior middle, posterior middle and posterior) localization of SOZ.Results:We analysed 122 seizures in 57 patients. Seizures were globally characterized by complex behaviors, typically natural seeming and often accompanied by emotional components.All objective ictal variables considered (pronation of the body or getting up from a lying/sitting position, tonic/dystonic posturing, hand movements, asymmetry, vocalizations, fluidity and repetitiveness of motor manifestations, awareness and emotional and autonomic components) were differently distributed among CC subregions (p<.05) Along the rostro-caudal axis fluidity and repetitiveness of movement, vocalizations, body pronation and emotional components decrease anterior-posteriorly, while tonic/dystonic postures, signs of lateralization and awareness increase.Vestibular and asymmetric somatosensory, somatosensory and epigastric and enteroceptive/autonomic symptoms were distributed differently among CC subregions (p<.05). Along the rostro-caudal axis vestibular, somatosensory and somatosensory asymmetric symptoms increase anterior-posterior.Discussion:CE is characterized by a spectrum of semeiological manifestations with a topographic distribution. CE semiology could indicate which cingulate sector is mainly involved.

Characteristics and Neural Correlates of Emotional Behavior during Prefrontal Seizures

“…Because mesial temporal seizures may also manifest fearful/anxious aura and fearful facial expression, 7,29 this may reflect a continuum involving connected temporal and prefrontal components of the limbic system. Previous SEEG studies have reported fear behavior during seizures with ventromedial PFC seizure organization, [9][10][11]13 with anterior cingulate localizations, 36 and with extrafrontal seizure localizations, especially temporal or insular, often involving early propagation to frontal lobe. 6,30 Aggressive behavior during seizures was previously noted to be commoner in male patients with frontotemporal seizures and could be triggered by intrusion into the patient's peripersonal space.…”

Anterior Cingulate Epilepsy: A Review

“…3,4,7 A rostrocaudal axis of functional organization and connectivity is increasingly recognized in the literature. 38,39 Oane et al 39 reported strong connections between the ACC and ipsilateral orbitofrontal cortex, amygdala, and contralateral ACC, whereas the aMCC has connections to the prefrontal regions, premotor and supplementary motor areas, and mesial parietal regions.…”

70 Years of Human Cingulate Cortex Stimulation. Functions and Dysfunctions Through the Lens of Electrical Stimulation

“…This fact cannot be explained by an alleged inability of intracerebral stimulations to generate pain, as witnessed by the fact that painful sensations are more frequently reported following the stimulation of the insular cortex, that is, the other node of the Pain Matrix. [95][96][97][98] Similarly, painful sensations are not part of the manifestations of cingulate epilepsy, 61 although they are more frequently reported in the case of insular seizures. [99][100][101][102] These facts raise a question concerning the true nature of the activation reported by neuroimaging studies on pain perception and, more specifically, regarding the hypothesis that the anterior cingulate (either pACC or pMCC) is part of the network through which pain is generated from nociception.…”