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Yan Z, Yang Y, Wang J, Deng Q, Zhang L, Wang M, Zhou J, Guan Y, Luan G, Wang M. Posterior cingulate epilepsy: Seizure semiology and intracranial electrical stimulation using SEEG. Seizure 2024; 119:28-35. [PMID: 38772097 DOI: 10.1016/j.seizure.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024] Open
Abstract
PURPOSE This study aimed to explore seizure semiology and the effects of intracerebral electrical stimulation on the human posterior cingulate cortex (PCC) using Stereoelectroencephalography (SEEG) to deepen our comprehension of posterior cingulate epilepsy (PCE). METHODS This study examined the characteristics of seizures through video documentation, by assessing the outcomes of intracranial electrical stimulation (iES) during SEEG. We further identified the connection between the observed semiology and precise anatomical locations within the PCC subregions where seizure onset zones (SOZ) were identified. RESULTS Analysis was conducted on 59 seizures from 15 patients recorded via SEEG. Behavioural arrest emerged as the predominant manifestation across the PCC subregions. Where ictal activity extended to both the mesial and lateral temporal cortex, automatism was predominantly observed in seizures originating from the ventral PCC (vPCC). The retrosplenial cortex (RSC) is associated with complex motor behaviour, with seizure discharges spreading to the temporal lobe. Seizures originating from the PCC include axial tonic and autonomic seizures. Only one case of positive clinical seizures was documented. High frequencies of iES within the PCC induced various clinical responses, categorised as vestibular, visual, psychological, and autonomic, with vestibular reactions primarily occurring in the dorsal PCC (dPCC) and RSC, visual responses in the left RSC, and autonomic reactions in the vPCC and RSC. CONCLUSION The manifestations of seizures in PCE vary according to the SOZ and the patterns of seizure propagation. The occurrence of seizures induced by iES is exceedingly rare, indicating that mapping of the PCC could pinpoint the primary sector of PCC.
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Affiliation(s)
- Zhaofen Yan
- Department of Neurology, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China
| | - Yujiao Yang
- Department of Neurology, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China
| | - Jing Wang
- Department of Neurology, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China
| | - Qin Deng
- Department of Neurology, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China
| | - Liping Zhang
- Department of Neurology, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China
| | - Minghui Wang
- Department of Neurology, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China
| | - Jian Zhou
- Department of Epilepsy Center, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China
| | - YuGuang Guan
- Department of Epilepsy Center, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China
| | - Guoming Luan
- Department of Epilepsy Center, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China.
| | - Mengyang Wang
- Department of Neurology, Sanbo Hospital, Capital Medical University, No 50, Xiang-shan-yi-ke-song, Street, HaiDian District, Beijing 100053, China.
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Mahgoub R, Bayram AK, Spencer DD, Alkawadri R. Functional parcellation of the cingulate gyrus by electrical cortical stimulation: a synthetic literature review and future directions. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332246. [PMID: 38242679 DOI: 10.1136/jnnp-2023-332246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/30/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The cingulate gyrus (CG), a brain structure above the corpus callosum, is recognised as part of the limbic system and plays numerous vital roles. However, its full functional capacity is yet to be understood. In recent years, emerging evidence from imaging modalities, supported by electrical cortical stimulation (ECS) findings, has improved our understanding. To our knowledge, there is a limited number of systematic reviews of the cingulate function studied by ECS. We aim to parcellate the CG by reviewing ECS studies. DESIGN/METHODS We searched PubMed and Embase for studies investigating CG using ECS. A total of 30 studies met the inclusion criteria. We evaluated the ECS responses across the cingulate subregions and summarised the reported findings. RESULTS We included 30 studies (totalling 887 patients, with a mean age of 31.8±9.8 years). The total number of electrodes implanted within the cingulate was 3028 electrode contacts; positive responses were obtained in 941 (31.1%, median percentages, 32.3%, IQR 22.2%-64.3%). The responses elicited from the CG were as follows. Simple motor (8 studies, 26.7 %), complex motor (10 studies, 33.3%), gelastic with and without mirth (7 studies, 23.3%), somatosensory (9 studies, 30%), autonomic (11 studies, 36.7 %), psychic (8 studies, 26.7%) and vestibular (3 studies, 10%). Visual and speech responses were also reported. Despite some overlap, the results indicate that the anterior cingulate cortex is responsible for most emotional, laughter and autonomic responses, while the middle cingulate cortex controls most complex motor behaviours, and the posterior cingulate cortex (PCC) regulates visual, among various other responses. Consistent null responses have been observed across different regions, emphasising PCC. CONCLUSIONS Our results provide a segmental mapping of the functional properties of CG, helping to improve precision in the surgical planning of epilepsy.
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Affiliation(s)
- Rawan Mahgoub
- Department of Neurology, The University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Ayse Kacar Bayram
- Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey
| | - Dennis D Spencer
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rafeed Alkawadri
- Department of Neurology, The University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
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Taussig D, Mazzola L, Petrescu AM, Aghakhani N, Bouilleret V, Dorfmüller G, Ferrand-Sorbets S, Herbrecht A, Isnard J. Deep retroinsular and parieto-opercular origin of vestibular symptoms: A stereoelectrocenphalography (SEEG) study. Epilepsy Behav 2023; 149:109509. [PMID: 37935078 DOI: 10.1016/j.yebeh.2023.109509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
Several studies have shown that the retroinsular and posterior parietal operculum regions play a central role in vestibular processing. Electrical stimulations performed during stereoelectroencephalography (SEEG) in patients with focal drug-resistant epilepsy could contribute to the analysis of this area. Among the 264 SEEGs performed in both an adult and a paediatric epilepsy surgery centre, we retrospectively identified 24 patients (9%) reporting vertigo during electrical stimulations (ES). In seven of them (29% of patients experiencing vertigo during ES), it was evoked by stimulating the retroinsular region. The reported responses were mostly not rotatory sensations but actually illusions of body, limb or limb segment movement. The involved area is limited. Moreover, two patients reported having the same symptoms at the beginning of their seizures starting in the same region. Our case study confirms the pivotal role of the retroinsular and posterior parietal operculum areas in vestibular responses, and we therefore advise the exploration of this region when patients report an illusion of body movement at the beginning of their seizures.
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Affiliation(s)
- Delphine Taussig
- Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France.
| | - Laure Mazzola
- Neurology Department, University Hospital, Saint-Etienne, France; NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| | - Ana Maria Petrescu
- Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France
| | - Nozar Aghakhani
- Université Paris Saclay-APHP, Neurochirurgie, Le Kremlin Bicêtre, France
| | - Viviane Bouilleret
- Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France; Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Orsay, France
| | - Georg Dorfmüller
- Hôpital Fondation Rothschild, Neurochirurgie Pédiatrique, Paris, France
| | | | - Anne Herbrecht
- Université Paris Saclay-APHP, Neurochirurgie, Le Kremlin Bicêtre, France
| | - Jean Isnard
- NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France; Hospices Civils de Lyon, Neurological Hospital, Department of Functional Neurology and Epileptology, Lyon F - 69003, France
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