Switch-Off response to mid-cingulate cortex stimulation: a video case report

Clinical Neurophysiology Practice, vol. 10, pp. 524–526

Abstract

• Mid-cingulum cortex stimulation elicited sensory and negative motor phenomena. • Mid-cingulum cortex stimulation triggered an unusual, complex behavioural response. • Mid-cingulum plays a role in behavioural network and sensorimotor integration. Electrical cortical stimulation (ECS) is commonly used during invasive presurgical evaluation of drug-resistant focal epilepsy for functional mapping and delineation of the epileptogenic zone. A 31-year-old woman underwent stereo-EEG evaluation for presurgical assessment of drug-resistant focal epilepsy, likely left frontal or multifocal. During 50 Hz ECS of the right mid-cingulate cortex, a reproducible behavioural response was observed, characterised by left ear popping, head drop, eye closure, and speech/motor arrest, without loss of awareness. This semiology differed from her habitual seizures, and the region was not considered part of the presumed epileptogenic zone. This case represents a rare video-documentation of stimulation-induced complex motor and behavioural response localised to the mid-cingulate cortex and supports mid-cingulate’s role as connection hub for volitional control and sensorimotor integration.

Authors 6

1. Paola Vassallo Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center · Stichting Epilepsie Instellingen Nederland · UCL Queen Square Institute of Neurology · University College London · Epilepsy Society

   Affiliation as printed

   Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK

   Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK

   Department of Neurology, Leiden University Medical Centre, Leiden 2333 ZA, Netherlands

   Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, Netherlands

2. Olivia V. Poole

   National Hospital for Neurology and Neurosurgery · UCL Queen Square Institute of Neurology · University College London

   Affiliation as printed

   Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK

   National Hospital Neurology and Neurosurgery, Department of Clinical Neurophysiology, London WC1N 3BG, UK

3. Davide Giampiccolo

   Cleveland Clinic London · National Hospital for Neurology and Neurosurgery · UCL Queen Square Institute of Neurology · University College London

   Affiliation as printed

   Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK

   Institute of Neurosciences, Cleveland Clinic London London SW1X 7HY, UK

   Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK

4. Umesh Vivekananda

   National Hospital for Neurology and Neurosurgery · UCL Queen Square Institute of Neurology · University College London · Epilepsy Society

   Affiliation as printed

   Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK

   Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK

   National Hospital Neurology and Neurosurgery, Department of Clinical Neurophysiology, London WC1N 3BG, UK

5. John Sidney Duncan

   UCL Queen Square Institute of Neurology · University College London · Epilepsy Society

   Affiliation as printed

   Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK

   Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK

6. Beate Diehl corresponding

   National Hospital for Neurology and Neurosurgery · UCL Queen Square Institute of Neurology · University College London

   Affiliation as printed

   Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK

   National Hospital Neurology and Neurosurgery, Department of Clinical Neurophysiology, London WC1N 3BG, UK