Electroclinical features and surgical outcome of cingulate epilepsy

Cingulate epilepsy is rare and can manifest with variable semiology features. The symptomatic diversity elucidates ictal involvement of certain subregions of the cingulate gyrus and early spread patterns. Knowledge of the features of cingulate epilepsy is important for better localization and surgical strategy.

The purpose of this study was to characterize the electroclinical features and report our experience in the diagnosis and surgical treatment of patients with focal epilepsy originating from the cingulate gyrus.

Thirty-one patients with epilepsy were retrospectively analyzed (mean age, 21; range 2-48), who had a mean epilepsy duration of 10 years (range 1-23). We report the clinical semiology, the scalp electroencephalography (EEG)/stereo-electroencephalography (SEEG) findings, surgical strategy, and postoperative follow-up (mean 48 months; range 12-136).

Twelve patients (38.7 %) had circumscribed lesions on magnetic resonance imaging (MRI). All patients underwent noninvasive presurgical evaluation, and 26 (83.9 %) underwent invasive recordings with SEEG (n = 18) or subdural electrodes (n = 8). The ictal patterns of scalp EEG were various. The anterior cingulate epilepsy (ACE) patients showed ipsilateral frontal, frontal-temporal, or bifrontal regions discharges. The ictal discharges involved the ipsilateral frontal, temporal, or central-parietal regions in patients with middle cingulate epilepsy (MCE), and the posterior cingulate epilepsy (PCE) patients showed ipsilateral temporal, occipital-temporal, bitemporal-parietal, or generalized discharges. Secondary generalization seizures originated from each subregion of the cingulate gyrus. The ACE patients showed hypermotor seizures, including twisting trunk, pedaling, and flailing. Limbs or body trembling was observed in both MCE and PCE patients, and dialeptic seizures were observed in PCE patients. 58.1 % of patients were seizure-free, and 77.4 % had a satisfactory surgical outcome (Engel I and II).

Cingulate epilepsy is a rare and diagnostically challenging form of epilepsy with diverse and variable electroclinical features. In patients with non-lesional MRI, invasive recording is required to identify defined seizure focus, and the surgical outcome of 1-year follow-up is favorable.