Multifocal Epilepsy and Non-dominant Cingulate Lesion

This chapter presents a patient with pharmacoresistant multifocal epilepsy and a single vascular lesion in the anterior cingulate gyrus. The presentation and EEG findings of patients with cingulate epilepsy, the extensive and complex connectivity of the cingulate cortex with other cortices, and surgical outcomes are discussed. We also briefly examine data regarding thalamic neurostimulation in patients with multifocal epilepsy. We describe the data regarding the predictive value of high- and low-frequency stimulation induced-seizures when spontaneous habitual seizures cannot be captured. We discuss the definition of stimulation-induced auras with and without EEG changes and their prognostic role in surgical outcome determination. Semiologies such as ictal tachycardia, ictal speech, and ictal hiccups are analyzed. Finally, we discuss the withdrawal process of anti-seizure medications during admission to the epilepsy monitoring unit.