Cingulate Epilepsy

Cytoarchitecture:
-The cingulate gyri(CG) are divided into anterior and posterior parts by VCP line.
Anterior CG
-The anterior part consists of the perigenual portion, areas 25 and 33, and of the midcingulate portion,
areas 24 and 32.
-The anterior cingulate cortex is agranular.
Posterior CG
-The posterior CG: areas 29, 30, and 26 are buried in the depths of the pericallosal sulcus.
-The PCC is characterized by granular layers II and IV, except for area 30 whose layer IV is dysgranular.

Connections
-Cingulate cortex is a part of the limbic system and is a component of the Papez circuit.
-Output from amygdala, hippocampus, entorhinal cortex travels via the fornix to the mammillary bodies of the
hypothalamus.
-From the mammillary bodies via the mammillothalamic tract to the anterior thalamic nucleus
-From the anterior thalamic nucleus, the output tranvels via the thalamocortical tract to CG.
-From CG gyrus back to amygdalus and hippocampus via cingulum.

Afferents
• Frontal lobe (esp. dorsolateral and orbital areas) (mainly to area 24(ACC))
• Parietal lobe (mainly to area 23 (PCC))
• Insula cortex (ACC)
• Small proportion of afferents from the occipital lobe (PCC)

Efferents
• Area 24 (AC)
• Premotor cortex
• Orbito-frontal cortex
• Inferior parietal lobe
• Anterior insular cortex
• Perirhinal cortex
• Laterobasal nucleus of the amygdala
• Area 23 (PC)
• Dorsal prefrontal cortex
• Rostral orbital cortex
• Parietotemporal cortex (posterior part of the inferior parietal lobule and superior temporal
sulcus)
• Parahippocampal gyrus
Epilepsy Classification
• Epileptic Paroxysmal Episode
• Epileptogenic Zone: right mesial frontal lobe (anterior cingulate gyrus)
• Semiology: Cephalic aura->Hypermotor Seizure
• Etiology: FCD 1b
• Related Medical Conditions: depression
Anterior Cingulate Epilepsy (n=10)
Typical (Bancaud) (n=6)
Auras Auras in 3 patients (50%)
-all: fear
-1 Pt : contralat. Ill-defined
sensory auras and freezing
sensation
No auras in 3 patients (50%)
Motor Component All: hypermotor sz
1 Pt had contralateral simple
motor sz
Vocalization 4 Pt (80%): vocalization
1 Pt (20%): nonmirthful
laughter
Consciousness 0 Pt: complete loss of
consciousness
6 Pt: quick recovery
2nd GTC 4 Pt: never had 2nd GTC
1 Pt: had one GTC during off
AEDs
Interictal Scalp EEG 2 Pt: interictal epileptiform
d/c in frontocentral region
Ictal Scalp EEG 3 Pt: Ictal EEG changes,
mostly obscured by muscle
artifacts, when discernible,
pointed to the ipsilateral
frontocentral region
Median Seizure 30 sec
duration (sec)
Atypical(n=4)
Auras in 1 Pt (25%)
-Freezing sensation
All: simple motor seizures
1 Pt had automotor seizure
2 Pt(50%): vocalization
4 Pt (100%): complete loss of
consciousness in some or all
seizures
4 Pt: had 2nd GTC
1 Pt: bilateral temporal
epileptiform discharges
3 Pt: Ictal EEG changes
-2 Pt: Ipsilateral frontocentral
region
-1 Pt: bilateral hemisphere
150 sec
Posterior Cingulate Epilepsy (n=4)
Auras in 4 Pt (100%)
-3 Pt: experiential auras (déjà
vu, jamais vu, depersonalization)
-2 Pt: abdominal aura
-1 Pt: gustatory aura
-1 Pt: subjective feeling of
falling
Simple motor and automotor sz
in 2 Pt
Dialeptic sz in 2 Pt
-
-
4 Pt: had 2nd GTC
Focal slowing
2 Pt: focal slowing in ipsilat
temporal region
1 Pt: bilateral temporal slowing
1 Pt: bi-frontal slowing
Interictal epileptiform d/c
4 Pt: had epileptiform d/c
-2 Pt: ipsi. ant. temporal
-1 Pt: ipsi. post. Temporal
-1 Pt: ipsi. frontal
4 Pt: Ictal EEG changes
-1 Pt: ipsilateral temporal
-2 Pt: widespread in ipsilateral
hemisphere
-1 Pt: widespread in bilateral
hemisphere
96.8 sec