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Switch-Off response to mid-cingulate cortex stimulation: a video case report
Paola Vassallo1,2,3,4, Olivia Poole1,5, Xiaodong Guan1
1Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.
Background:
Electrical cortical stimulation (ECS) is commonly used during invasive presurgical evaluation of drug-resistant focal epilepsy for functional mapping and delineation of the epileptogenic zone.
Case Presentation:
A 31-year-old woman underwent stereo-EEG evaluation for presurgical assessment of drug-resistant focal epilepsy, likely left frontal or multifocal. During 50 Hz ECS of the right mid-cingulate cortex, a reproducible behavioural response was observed, characterised by left ear popping, head drop, eye closure, and speech/motor arrest, without loss of awareness. This semiology differed from her habitual seizures, and the region was not considered part of the presumed epileptogenic zone.
Conclusion:
This case represents a rare video-documentation of stimulation-induced complex motor and behavioural response localised to the mid-cingulate cortex and supports mid-cingulate's role as connection hub for volitional control and sensorimotor integration.
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