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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; 95:704-721. [PMID: 38242679 DOI: 10.1136/jnnp-2023-332246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Cui CK, Wong WK, Wong CH, Gill D, Fong MWK. Case Report: Focal, generalized, or both: does generalized network involvement preclude successful epilepsy surgery? FRONTIERS IN NETWORK PHYSIOLOGY 2024; 4:1425329. [PMID: 39055857 PMCID: PMC11269090 DOI: 10.3389/fnetp.2024.1425329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Abstract
We present two cases with focal seizures where scalp electroencephalography (EEG) had prominent features of a developmental and epileptic encephalopathy (DEE): Case 1: a 17-year-old male with complex motor seizures whose EEG demonstrated a slow spike-and-wave pattern and generalized paroxysmal fast activity (GPFA). Case 2: a 12-year-old male with startle-induced asymmetric tonic seizures whose EEG also had a slow spike-and-wave pattern. Both patients had intracranial EEG assessment, and focal cortical resections resulted in long-term seizure freedom and resolution of generalized findings. These cases exemplify patients with focal epilepsy with networks that share similarities to generalized epilepsies, and importantly, these features did not preclude curative epilepsy surgery.
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Affiliation(s)
- Cathy K. Cui
- Westmead Comprehensive Epilepsy Centre, The University of Sydney, Sydney, NSW, Australia
| | - Wui-Kwan Wong
- Westmead Comprehensive Epilepsy Centre, The University of Sydney, Sydney, NSW, Australia
- T. Y. Nelson Department of Neurology and Neurosurgery, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Chong H. Wong
- Westmead Comprehensive Epilepsy Centre, The University of Sydney, Sydney, NSW, Australia
- T. Y. Nelson Department of Neurology and Neurosurgery, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Deepak Gill
- Westmead Comprehensive Epilepsy Centre, The University of Sydney, Sydney, NSW, Australia
- T. Y. Nelson Department of Neurology and Neurosurgery, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Michael W. K. Fong
- Westmead Comprehensive Epilepsy Centre, The University of Sydney, Sydney, NSW, Australia
- T. Y. Nelson Department of Neurology and Neurosurgery, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, United States
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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] [MESH Headings] [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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Kokkinos V. Interictal Electroencephalography and Functional Magnetic Resonance Imaging Reveals Involvement of Mesial Anterior Frontal Structures in Patients With Hyperkinetic Semiology Type I. J Clin Neurophysiol 2024:00004691-990000000-00146. [PMID: 38913939 DOI: 10.1097/wnp.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
PURPOSE This work investigates the presence of common anatomic regions associated with interictal activity in patients with hyperkinetic seizures type I by means of concurrent electroencephalography and functional magnetic resonance imaging. METHODS Six patients with hyperkinetic seizures type I were evaluated with video-EEG and electroencephalography and functional magnetic resonance imaging in the context of their presurgical evaluation. Statistical Parametric Mapping was used to perform a correlation study between the occurrence of interictal spikes on EEG and suprathreshold blood oxygen level-dependent changes in the whole-brain volume. RESULTS In all patients, Statistical Parametric Mapping revealed suprathreshold blood oxygen level-dependent clusters in the mesial anterior frontal areas, including the rostral mesial superior frontal gyrus and the anterior cingulate, associated with the patients' typical interictal activity. CONCLUSIONS The electroencephalography and functional magnetic resonance imaging findings contribute to our understanding of hyperkinetic seizures type I semiology generation and can inform stereo-EEG targeting for surgical planning in refractory cases.
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Affiliation(s)
- Vasileios Kokkinos
- Comprehensive Epilepsy Center, Northwestern Memorial Hospital, Chicago, Illinois, U.S.A. ; and
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Illinois, U.S.A
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van Dalen T, Kirkham JF, Chari A, D'Arco F, Moeller F, Eltze C, Cross JH, Tisdall MM, Thornton RC. Characterizing Frontal Lobe Seizure Semiology in Children. Ann Neurol 2024; 95:1138-1148. [PMID: 38624073 DOI: 10.1002/ana.26922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The objective was to analyze seizure semiology in pediatric frontal lobe epilepsy patients, considering age, to localize the seizure onset zone for surgical resection in focal epilepsy. METHODS Fifty patients were identified retrospectively, who achieved seizure freedom after frontal lobe resective surgery at Great Ormond Street Hospital. Video-electroencephalography recordings of preoperative ictal seizure semiology were analyzed, stratifying the data based on resection region (mesial or lateral frontal lobe) and age at surgery (≤4 vs >4). RESULTS Pediatric frontal lobe epilepsy is characterized by frequent, short, complex seizures, similar to adult cohorts. Children with mesial onset had higher occurrence of head deviation (either direction: 55.6% vs 17.4%; p = 0.02) and contralateral head deviation (22.2% vs 0.0%; p = 0.03), ictal body-turning (55.6% vs 13.0%; p = 0.006; ipsilateral: 55.6% vs 4.3%; p = 0.0003), and complex motor signs (88.9% vs 56.5%; p = 0.037). Both age groups (≤4 and >4 years) showed hyperkinetic features (21.1% vs 32.1%), contrary to previous reports. The very young group showed more myoclonic (36.8% vs 3.6%; p = 0.005) and hypomotor features (31.6% vs 0.0%; p = 0.003), and fewer behavioral features (36.8% vs 71.4%; p = 0.03) and reduced responsiveness (31.6% vs 78.6%; p = 0.002). INTERPRETATION This study presents the most extensive semiological analysis of children with confirmed frontal lobe epilepsy. It identifies semiological features that aid in differentiating between mesial and lateral onset. Despite age-dependent differences, typical frontal lobe features, including hyperkinetic seizures, are observed even in very young children. A better understanding of pediatric seizure semiology may enhance the accuracy of onset identification, and enable earlier presurgical evaluation, improving postsurgical outcomes. ANN NEUROL 2024;95:1138-1148.
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Affiliation(s)
- Thijs van Dalen
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jessica F Kirkham
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Aswin Chari
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Felice D'Arco
- Department of Pediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Friederike Moeller
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Christin Eltze
- Department of Neurology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - J Helen Cross
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Martin M Tisdall
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Rachel C Thornton
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Department of Neurophysiology, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
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6
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Caruana F. Positive emotions elicited by cortical and subcortical electrical stimulation: A commentary on Villard et al. (2023). Cortex 2024; 174:234-237. [PMID: 37659914 DOI: 10.1016/j.cortex.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Fausto Caruana
- Institute of Neuroscience, National Research Council of Italy (CNR), Via Volturno 39/E, 43125 Parma, Italy.
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Beltrán-Corbellini Á, Toledano R, Budke M, García-Morales I, Herráez E, Sánchez-Miranda Román I, Gil-Nagel A. Anterior midcingulate epilepsy: When semiology is of paramount importance to find the needle in the haystack. Epileptic Disord 2024; 26:161-163. [PMID: 37850932 DOI: 10.1002/epd2.20173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
Content available: Video
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Affiliation(s)
| | - Rafael Toledano
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Marcelo Budke
- Department of Neurosurgery, Hospital Ruber Internacional, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Erika Herráez
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | | | - Antonio Gil-Nagel
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
- Fundación Iniciativa por las Neurociencias (FINCE), Madrid, Spain
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Abstract
PURPOSE OF REVIEW Electrical stimulation of the peripheral and central vestibular system using noninvasive (galvanic vestibular stimulation, GVS) or invasive (intracranial electrical brain stimulation, iEBS) approaches have a long history of use in studying self-motion perception and balance control. The aim of this review is to summarize recent electrophysiological studies of the effects of GVS, and functional mapping of the central vestibular system using iEBS in awake patients. RECENT FINDINGS The use of GVS has become increasingly common in the assessment and treatment of a wide range of clinical disorders including vestibulopathy and Parkinson's disease. The results of recent single unit recording studies have provided new insight into the neural mechanisms underlying GVS-evoked improvements in perceptual and motor responses. Furthermore, the application of iEBS in patients with epilepsy or during awake brain surgery has provided causal evidence of vestibular information processing in mostly the middle cingulate cortex, posterior insula, inferior parietal lobule, amygdala, precuneus, and superior temporal gyrus. SUMMARY Recent studies have established that GVS evokes robust and parallel activation of both canal and otolith afferents that is significantly different from that evoked by natural head motion stimulation. Furthermore, there is evidence that GVS can induce beneficial neural plasticity in the central pathways of patients with vestibular loss. In addition, iEBS studies highlighted an underestimated contribution of areas in the medial part of the cerebral hemispheres to the cortical vestibular network.
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Affiliation(s)
- Christophe Lopez
- Aix Marseille Univ, CNRS, Laboratory of Cognitive Neuroscience (LNC), FR3C, Marseille, France
| | - Kathleen E. Cullen
- Department of Biomedical Engineering, Johns Hopkins University
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
- Department of Neuroscience, Johns Hopkins University
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore 21205 MD, USA
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d'Orio P, Revay M, Bevacqua G, Battista F, Castana L, Squarza S, Chiarello D, Lo Russo G, Sartori I, Cardinale F. Stereo-electroencephalography (SEEG)-Guided Surgery in Epilepsy With Cingulate Gyrus Involvement: Electrode Implantation Strategies and Postoperative Seizure Outcome. J Clin Neurophysiol 2023; 40:516-528. [PMID: 36930225 DOI: 10.1097/wnp.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Surgical treatment of cingulate gyrus epilepsy is associated with good results on seizures despite its rarity and challenging aspects. Invasive EEG monitoring is often mandatory to assess the epileptogenic zone in these patients. To date, only small surgical series have been published, and a consensus about management of these complex cases did not emerge. The authors retrospectively analyzed a large surgical series of patients in whom at least part of the cingulate gyrus was confirmed as included in the epileptogenic zone by means of stereo-electroencephalography and was thus resected. One hundred twenty-seven patients were selected. Stereo-electroencephalography-guided implantation of intracerebral electrodes was performed in the right hemisphere in 62 patients (48.8%) and in the left hemisphere in 44 patients (34.7%), whereas 21 patients (16.5%) underwent bilateral implantations. The median number of implanted electrodes per patient was 13 (interquartile range 12-15). The median number of electrodes targeting the cingulate gyrus was 4 (interquartile range 3-5). The cingulate gyrus was explored bilaterally in 19 patients (15%). Complication rate was 0.8%. A favorable outcome (Engel class I) was obtained in 54.3% of patients, with a median follow-up of 60 months. The chance to obtain seizure freedom increased in cases in whom histologic diagnosis was type-IIb focal cortical dysplasia or tumor (mostly ganglioglioma or dysembryoplastic neuroepithelial tumor) and with male gender. Higher seizure frequency predicted better outcome with a trend toward significance. Our findings suggest that stereo-electroencephalography is a safe and effective methodology in achieving seizure freedom in complex cases of epilepsy with cingulate gyrus involvement.
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Affiliation(s)
- Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Martina Revay
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Bevacqua
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Neurosurgery Unit, Department of Translational Medicine, Ferrara University, Ferrara, Italy
| | - Francesca Battista
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology, and Child Health, Careggi University Hospital and University of Florence, Florence, Italy; and
| | - Laura Castana
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Squarza
- Neuroradiology Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Chiarello
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Cardinale
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
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Pepin C, Brochu K, Lessard-Bonaventure P, Nguyen DK, Martineau L. Posterior Cingulate Epilepsy: A Systematic Review. J Clin Neurophysiol 2023; 40:507-515. [PMID: 36930208 DOI: 10.1097/wnp.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY In this review, authors discuss epilepsy originating from posterior cingulate regions, a challenging entity to diagnose and most likely underrecognized. A systematic review of posterior middle and posterior cingulate epilepsy cases was conducted to present a summary of current knowledge about this localization-based type of epilepsy. The literature search identified 32 articles, for a total of 69 patients (34 with posterior middle cingulate epilepsy [pMCE] and 35 with posterior cingulate epilepsy [PCE]). Most patients were children and young adults with drug-resistant lesional epilepsy with high seizure burden. In both groups, most patients reported auras, mainly sensory, but various types were reported, including autonomic, behavioral, and cognitive manifestations. Most pMCE and PCE showed motor manifestations (mainly respectively asymmetric tonic posturing and automotor features). Impaired awareness during seizures was more frequently reported in PCE than in pMCE. As for ictal scalp EEG, epileptogenic abnormalities were poorly lateralized and did not localize the seizure onset zone. An ictal temporal involvement was only observed in PCE. Interictal EEG findings were nonspecific. As for other presurgical noninvasive investigations, data are limited, and no studies have adequately assessed their value. Partly explained by our inclusion criteria, most patients underwent a surgical procedure (either lesionectomy or resection of epileptogenic zone as defined by intracranial EEG study results), which overall yielded good outcomes.
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Affiliation(s)
- Catherine Pepin
- Department of Medicine, Neurology Division Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada
| | - Karine Brochu
- Department of Medicine, Neurology Division Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada
| | - Paule Lessard-Bonaventure
- Department of Surgery, Neurosurgery Division, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada and
| | - Dang Khoa Nguyen
- Department of Medicine, Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM)-Université de Montréal, Montréal, QC, Canada
| | - Laurence Martineau
- Department of Medicine, Neurology Division Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada
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Pana RM, Nguyen DK. Anterior Cingulate Epilepsy: A Review. J Clin Neurophysiol 2023; 40:501-506. [PMID: 36930222 DOI: 10.1097/wnp.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY In this review, the semiology, and characteristics of noninvasive investigations suggestive of anterior cingulate and anterior midcingulate epilepsy are detailed by the authors. The clinical presentation is representative of a recently recognized rostrocaudal gradient of functional connectivity with seizures of the anterior cingulate cortex manifesting emotional and interoceptive aura followed by a hyperkinetic or complex motor seizures. The few reports of anterior midcingulate epilepsy show a trend toward a higher proportion of sensory auras and premotor semiology. Ictal pouting, vocalizations, and, in particular, laughter are strong indicators of epilepsy arising or spreading to this region. Although scalp EEG was traditionally thought to provide little information, the data provided in this review demonstrate that most patients will have abnormalities over the frontal or frontotemporal regions. Frontotemporal abnormalities at least interictally provide valuable information regarding lateralization. The etiology of epilepsy arising from the anterior cingulate region seems to be most frequently secondary to focal cortical dysplasia (FCD), followed by neoplasms and vascular lesions, particularly cavernomas, although one cannot rule out a publication bias. Findings of nuclear medicine imaging is seldomly reported but both positron emission tomography and ictal single-photon computed tomography can identify the generator or the network often showing abnormalities extending to the frontal regions. The few available magnetoencephalography (MEG) studies reveal mixed results, sometimes providing false lateralization of the focus. Anterior cingulate epilepsy is difficult to recognize, but the features summarized in this review should prompt suspicion in clinical practice.
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Affiliation(s)
- Raluca M Pana
- Epilepsy Service and EEG Department, Montreal Neurological Institute and Hospital, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Dang K Nguyen
- Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada; and
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Pelliccia V, Del Vecchio M, Avanzini P, Revay M, Sartori I, Caruana F. 70 Years of Human Cingulate Cortex Stimulation. Functions and Dysfunctions Through the Lens of Electrical Stimulation. J Clin Neurophysiol 2023; 40:491-500. [PMID: 36007014 DOI: 10.1097/wnp.0000000000000961] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY In this review, we retrace the results of 70 years of human cingulate cortex (CC) intracerebral electrical stimulation and discuss its contribution to our understanding of the anatomofunctional and clinical aspects of this wide cortical region. The review is divided into three main sections. In the first section, we report the results obtained by the stimulation of the anterior, middle, and posterior CC, in 30 studies conducted on approximately 1,000 patients from the 1950s to the present day. These studies show that specific manifestations can be reliably associated with specific cingulate subfields, with autonomic, interoceptive, and emotional manifestations clustered in the anterior cingulate, goal-oriented motor behaviors elicited from the anterior midcingulate and a variety of sensory symptoms characterizing the posterior cingulate regions. In the second section, we compare the effect of CC intracerebral electrical stimulation with signs and manifestations characterizing cingulate epilepsy, showing that the stimulation mapping of CC subfields provides precious information for understanding cingulate epileptic manifestations. The last section tackles the issue of the discrepancy emerging when comparing the results of clinical (electrical stimulation, epilepsy) studies-revealing the quintessential affective and motor nature of the CC-with that reported by neuroimaging studies-which focus on high-level cognitive functions. Particular attention will be paid to the hypothesis that CC hosts a "Pain Matrix" specifically involved in pain perception, which we will discuss in the light of the fact that the stimulation of CC (as well as cingulate epileptic seizures) does not induce nociceptive effects.
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Affiliation(s)
- Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Center, ASST GOM Niguarda, Milano, Italy; and
| | - Maria Del Vecchio
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
| | - Pietro Avanzini
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
| | - Martina Revay
- "Claudio Munari" Epilepsy Surgery Center, ASST GOM Niguarda, Milano, Italy; and
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Center, ASST GOM Niguarda, Milano, Italy; and
| | - Fausto Caruana
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
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13
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Potegal M, Nordman JC. Non-angry aggressive arousal and angriffsberietschaft: A narrative review of the phenomenology and physiology of proactive/offensive aggression motivation and escalation in people and other animals. Neurosci Biobehav Rev 2023; 147:105110. [PMID: 36822384 DOI: 10.1016/j.neubiorev.2023.105110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023]
Abstract
Human aggression typologies largely correspond with those for other animals. While there may be no non-human equivalent of angry reactive aggression, we propose that human proactive aggression is similar to offense in other animals' dominance contests for territory or social status. Like predation/hunting, but unlike defense, offense and proactive aggression are positively reinforcing, involving dopamine release in accumbens. The drive these motivational states provide must suffice to overcome fear associated with initiating risky fights. We term the neural activity motivating proactive aggression "non-angry aggressive arousal", but use "angriffsberietschaft" for offense motivation in other animals to acknowledge possible differences. Temporal variation in angriffsberietschaft partitions fights into bouts; engendering reduced anti-predator vigilance, redirected aggression and motivational over-ride. Increased aggressive arousal drives threat-to-attack transitions, as in verbal-to-physical escalation and beyond that, into hyper-aggression. Proactive aggression and offense involve related neural activity states. Cingulate, insular and prefrontal cortices energize/modulate aggression through a subcortical core containing subnuclei for each aggression type. These proposals will deepen understanding of aggression across taxa, guiding prevention/intervention for human violence.
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Affiliation(s)
| | - Jacob C Nordman
- Department of Physiology, Southern Illinois University School of Medicine, Carbondale, IL, USA.
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14
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Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype? J Clin Med 2023; 12:jcm12010372. [PMID: 36615171 PMCID: PMC9821298 DOI: 10.3390/jcm12010372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory.
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15
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Nobili L, Frauscher B, Eriksson S, Gibbs SA, Halasz P, Lambert I, Manni R, Peter-Derex L, Proserpio P, Provini F, de Weerd A, Parrino L. Sleep and epilepsy: A snapshot of knowledge and future research lines. J Sleep Res 2022; 31:e13622. [PMID: 35487880 PMCID: PMC9540671 DOI: 10.1111/jsr.13622] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Sleep and epilepsy have a reciprocal relationship, and have been recognized as bedfellows since antiquity. However, research on this topic has made a big step forward only in recent years. In this narrative review we summarize the most stimulating discoveries and insights reached by the "European school." In particular, different aspects concerning the sleep-epilepsy interactions are analysed: (a) the effects of sleep on epilepsy; (b) the effects of epilepsy on sleep structure; (c) the relationship between epilepsy, sleep and epileptogenesis; (d) the impact of epileptic activity during sleep on cognition; (e) the relationship between epilepsy and the circadian rhythm; (f) the history and features of sleep hypermotor epilepsy and its differential diagnosis; (g) the relationship between epilepsy and sleep disorders.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatric Unit, Istituto G. Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sofia Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Steve Alex Gibbs
- Department of Neurosciences, Center for Advanced Research in Sleep Medicine, Sacred Heart Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Isabelle Lambert
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.,APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, CNRS UMR 5292/INSERM U1028, Lyon, France
| | - Paola Proserpio
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Provini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
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