The ventral precuneal-posterior cingulate region as a site of epileptogenicity

The ventral precuneal and posterior cingulate area (VP-PC) represents a distinct but topographically variable mesial parietal site of epileptogenicity that may manifest as a common temporal lobe-mediated ictal expression. In a review of records of 62 presumptive epilepsy surgery cases, two cases of primary epileptogenicity expressed within the VP-PC were identified and are detailed to bring attention to this electroencephalographically-hidden area of ictal expression. Details of their investigation and surgical treatment illustrate distinctly different approaches addressing the problem and bringing about a seizure-free outcome.

Brain-responsive corticothalamic stimulation in the centromedian nucleus for the treatment of regional neocortical epilepsy.

OBJECTIVE: The aim of the study was to determine if corticothalamic responsive stimulation targeting the centromedian nucleus of the thalamus (CMT) is a potential treatment for neocortical epilepsies with regional onsets. METHODS: We assessed efficacy and safety of CMT and neocortical responsive stimulation, detection, and stimulation programming, methods for implantation, and location and patterns of electrographic seizure onset and spread in 7 patients with medically intractable focal seizures with a regional neocortical onset. RESULTS: The median follow-up duration was 17 months (average: 17 months, range: 8-28 months). The median % reduction in disabling seizures (excludes auras) in the 7 patients was 88% (mean: 80%, range: 55-100%). The median % reduction in all seizure types (disabling + auras) was 73% (mean: 67%, range: 15-94%). There were no adverse events related to implantation of the responsive neurostimulator and leads or related to the delivery of responsive stimulation. Stimulation-related contralateral paresthesias were addressed by adjusting stimulation parameters in the clinic during stimulation testing. Electrographic seizures were detected in the CMT and neocortex in all seven patients. Four patients had simultaneous or near simultaneous seizure onsets in the neocortex and CMT and three had onsets in the neocortex with spread to the CMT. CONCLUSION: In this small series of patients with medically intractable focal seizures and regional neocortical onset, responsive neurostimulation to the neocortex and CMT improved seizure control and was well tolerated. SIGNIFICANCE: Responsive corticothalamic neurostimulation of the CMT and neocortex is a potential treatment for patients with regional neocortical epilepsies.

Human Left Anterior Cingulate Stimulation Elicits a Reproducible Micturition Response.

Electrical stimulation of a brain region producing a micturition response has never previously been described in the human. This report identifies the anterior cingulate gyrus as a brain region important in the micturition response. Stereo electroencephalography was performed in a 38-year-old female with medically refractory epilepsy. The response of the left anterior cingulate from low- to high-frequency brain stimulation was tested. Stimulation within the left anterior cingulate resulted in a reproducible micturition response. The response was dependent on the frequency of stimulation (present with stimulation at 50-150 Hz and not present at 5 or 350 Hz). These results provide evidence for the presence of a region within the human left anterior cingulate gyrus involved in producing the micturition response. This may have implications in the understanding of the physiological mechanisms of willful micturition and in the treatment of bladder disorders.