RT Journal Article
SR Electronic
T1 Association Between Semiology and Anatomo-functional Localization in Patients With Cingulate Epilepsy
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e2211
OP e2223
DO 10.1212/WNL.0000000000200145
VO 98
IS 22
A1 Pelliccia, Veronica
A1 Avanzini, Pietro
A1 Rizzi, Michele
A1 Caruana, Fausto
A1 Tassi, Laura
A1 Francione, Stefano
A1 Gozzo, Francesca
A1 Mariani, Valeria
A1 d'Orio, Piergiorgio
A1 Castana, Laura
A1 Mai, Roberto
A1 Terzaghi, Michele
A1 Nobili, Lino
A1 Sartori, Ivana
YR 2022
UL http://n.neurology.org/content/98/22/e2211.abstract
AB Background and Objectives Cingulate epilepsy (CE) is a rare type of focal epilepsy that is challenging to diagnose because of the polymorphic semiology of the seizures, mimicking other types of epilepsy, and the limited utility of scalp EEG.Methods We selected consecutive patients with drug-resistant CE who were seizure-free after surgery, with seizure onset zone (SOZ) confirmed in the cingulate cortex (CC) by histology or stereo EEG. We analyzed subjective and objective ictal manifestations using video recordings and correlated semiology with anatomical CC subregion (anterior, anterior middle, posterior middle, and posterior) localization of SOZ.Results We analyzed 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 arising 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 < 0.05). Along the rostro-caudal axis, fluidity and repetitiveness of movement, vocalizations, body pronation, and emotional components decreased anterior–posteriorly, whereas tonic/dystonic postures, signs of lateralization, and awareness increased. Vestibular and asymmetric somatosensory, somatosensory, and epigastric and enteroceptive/autonomic symptoms were distributed differently among CC subregions (p < 0.05). Along the rostro-caudal axis, vestibular, somatosensory, and somatosensory asymmetric symptoms increased anterior–posteriorly.Discussion CE is characterized by a spectrum of semiologic manifestations with a topographic distribution. CE semiology could indicate which cingulate sector is primarily involved.ACC=anterior cingulate cortex; aMCC=anterior midcingulate cortex; CC=cingulate cortex; CE=cingulate epilepsy; FCD=focal cortical dysplasia; MCC=midcingulate cortex; PCC=posterior cingulate cortex; pMCC=posterior midcingulate cortex; SEEG=stereo EEG; SOZ=seizure onset zone