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.
To characterize the clinical and electrophysiological findings of epilepsies arising from the
anterior and posterior cingulate gyrus.
Design, Setting, and Participants
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
Main Outcomes and Measures
The main outcome measure was improvement in seizure frequency following surgery. The clinical,
video electroencephalography, neuroimaging, pathology, and surgical outcome data were reviewed.
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 and Relevance
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.