title: Lesion-negative anterior cingulate epilepsy.
abstract: MRI-negative anterior cingulate epilepsy is a rare entity. Herein, we describe a case of MRI and functional imaging-negative intractable frontal lobe epilepsy in which, initially, secondary bilateral synchrony of surface and intracranial EEG and non-lateralizing semiology rendered identification of the epileptogenic zone difficult. A staged bilateral stereotactic EEG exploration revealed a very focal, putative ictal onset zone in the right anterior cingulate gyrus, as evidenced by interictal and ictal high-frequency oscillations (at 250Hz) and induction of seizures from the same electrode contacts by 50-Hz low-intensity cortical stimulation. This was subsequently confirmed by ILAE class 1 outcome following resection of the ictal onset and irritative zones. Histopathological examination revealed focal cortical dysplasia type 1b (ILAE Commission, 2011) as the cause of epilepsy. The importance of anatomo-electro-clinical correlation is illustrated in this case in which semiological and electrophysiological features pointed to the anatomical localization of a challenging, MRI-negative epilepsy.
authors.affiliation: Epilepsy Center, UH Case Medical Center, Cleveland, OH, USA.
authors.forename: Nuria
authors.initials: N
authors.lastname: Lacuey
authors.forename: Javier Chapa
authors.initials: JC
authors.lastname: Davila
authors.forename: Bilal
authors.initials: B
authors.lastname: Zonjy
authors.forename: Shahram
authors.initials: S
authors.lastname: Amina
authors.forename: Marta
authors.initials: M
authors.lastname: Couce
authors.forename: John
authors.initials: J
authors.lastname: Turnbull
authors.forename: Jonathan
authors.initials: J
authors.lastname: Miller
authors.forename: Hans
authors.initials: H
authors.lastname: Lüders
authors.forename: Samden D
authors.initials: SD
authors.lastname: Lhatoo
mesh_terms: D000328:Adult; D019465:Craniofacial Abnormalities; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis*; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis*; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000175:diagnosis*