title: Cingulate epilepsy: report of 3 electroclinical subtypes with surgical outcomes.
abstract: OBJECTIVE
  The literature on cingulate gyrus epilepsy in the magnetic resonance imaging era is limited to case reports and small case series. To our knowledge, this is the largest study of surgically confirmed epilepsy arising from the anterior or posterior cingulate region.
  
  
  OBJECTIVE
  To characterize the clinical and electrophysiological findings of epilepsies arising from the anterior and posterior cingulate gyrus.
  
  
  METHODS
  We studied consecutive cingulate gyrus epilepsy cases identified retrospectively from the Cleveland Clinic and University of Texas Southwestern Medical Center epilepsy databases from 1992 to 2009. Participants included 14 consecutive cases of cingulate gyrus epilepsies confirmed by restricted magnetic resonance image lesions and seizure freedom or marked improvement following lesionectomy.
  
  
  METHODS
  The main outcome measure was improvement in seizure frequency following surgery. The clinical, video electroencephalography, neuroimaging, pathology, and surgical outcome data were reviewed.
  
  
  RESULTS
  All 14 patients had cingulate epilepsy confirmed by restricted magnetic resonance image lesions and seizure freedom or marked improvement following lesionectomy. They were divided into 3 groups based on anatomical location of the lesion and corresponding seizure semiology. In the posterior cingulate group, all 4 patients had electroclinical findings suggestive of temporal origin of the epilepsy. The anterior cingulate cases were divided into a typical (Bancaud) group (6 cases with hypermotor seizures and infrequent generalization with the presence of fear, laughter, or severe interictal personality changes) and an atypical group (4 cases presenting with simple motor seizures and a tendency for more frequent generalization and less-favorable long-term surgical outcome). All atypical cases were associated with an underlying infiltrative astrocytoma.
  
  
  CONCLUSIONS
  Posterior cingulate gyrus epilepsy may present with electroclinical findings that are suggestive of temporal lobe epilepsy and can be considered as another example of pseudotemporal epilepsies. The electroclinical presentation and surgical outcome of lesional anterior cingulate epilepsy is possibly influenced by the underlying pathology. This study highlights the difficulty in localizing seizures arising from the cingulate gyrus in the absence of a magnetic resonance image lesion.
authors.affiliation: Cleveland Clinic Epilepsy Center, Cleveland, Ohio, USA. mhdrafeed.alkawadri@yale.edu
authors.forename: Rafeed
authors.initials: R
authors.lastname: Alkawadri
authors.forename: Norman K
authors.initials: NK
authors.lastname: So
authors.forename: Paul C
authors.initials: PC
authors.lastname: Van Ness
authors.forename: Andreas V
authors.initials: AV
authors.lastname: Alexopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000145:classification* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006179:Gyrus Cinguli / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult