Abstracts

Rationale: The cingulate gyrus connects extensively with structures within the limbic system and the SMA. Due to its deep and midline location, scalp video-EEG recordings often mislocalize the seizure onset. In this study, we will characterize the scalp electroclinical findings in ten patients with cingulate or peri-cingulate epilepsy who were operated with good outcomes (60% Engel Class I, the remainder Class 2/3, outcomes). Methods: Retrospective chart review of clinical histories, scalp video-EEG results, neuroimaging, pathology was performed on three non-lesional and seven lesional surgical cases, (conducted between 1998-2013, on 3 female and 7 male patients, between the ages of 1.5 and 41). Results: Ictal electroencephalographic changes were nonlateralized in 4 patients, lateralized and parasaggital in 4 others, or localized to the ipsilateral temporal region in two patients. Interictal epileptic discharges (IEDs) were detected in 8 patients, 2 had only slowing. IEDs were only frontal, frontocentral, central, and centroparietal in single cases, and temporal and multiregional in 2 patients, respectively. We identified three semiologies: hypermotor only in two, hypermotor/tonic in four, tonic only in one, automotor/hypomotor in three. Conclusions: Ictal onset, IEDs, and semiology were never discordantly lateralized from the seizure onset zone. The most anterior lesions were associated with hypermotor features and least likely to be lateralized on scalp EEG. Peri-cingulate lesions near the SMA were more commonly associated with tonic features and more often lateralized. Posterior cingulate lesions tended to present with temporal lobe semiology and EEG findings.