Overview

The cingulate cortex is a hub for functional connectivity in the brain, with extensive connections to other regions involved in cognitive, emotional, and sensorimotor processing. These connections are mediated by white matter tracts, such as the cingulum bundle, which connects different regions of the cingulate cortex and the prefrontal cortex, parietal cortex, and temporal cortex.

Cingulate epilepsy can originate from different regions of the cingulate cortex, and the specific location of the seizure focus can affect the clinical symptoms and response to treatment. Therefore, accurate localization of the seizure focus is crucial for effective management of cingulate epilepsy.

There have been several advances in the diagnosis and treatment of cingulate epilepsy in recent years. One major advance is the use of advanced neuroimaging and neurophysiological techniques such as magnetic resonance imaging (MRI), positron emission tomography (PET), and magnetoencephalography (MEG) to better localize the epileptogenic zone in this region. Some studies have shown that resection surgery has good results in seizure control.

Additionally, there has been growing interest in the use of neuromodulation techniques, such as responsive neurostimulation (RNS) and deep brain stimulation (DBS), for the treatment of cingulate epilepsy. These advances have the potential to improve outcomes for individuals with cingulate epilepsy, especially those who are difficult to manage with traditional medications or are not surgical candidates.

In this course, we will discuss the use of semiological, neuroimaging and neurophysio- logical techniques to design a SEEG implantation to identify the epileptogenic zone and eloquent network and to develop a surgical plan in patients with cingulate epilepsy.

Who Should Attend?

Neurologists and Neurosurgeons

Learning Objectives

At the completion of this activity, the participant should be able to:

• Recognize clinical manifestations of cingulate epilepsy, their electro-clinical evolution and correlation with non-invasive diagnostic modalities
• Discuss current insights in the functional anatomy and connectivity of the cingulate
• Integrate presurgical neurophysiological and imaging work-up towards a well-informed SEEG implantation strategy
• Interpret SEEG recordings and cortical stimulation responses in the context of all pre- SEEG workup data and arrive to a successful surgical strategy