Cingulate epilepsy: case series and literature review
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Authors
Benjamin, Benson
Kaur, Harpreet
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Issue Date
15/09/2025
Type
Journal article
Language
Keywords
Specialist and Integrated
Alternative Title
Abstract
Background
Cingulate epilepsy is a rare form of focal epilepsy originating in the cingulate cortex, a key region of the limbic system involved in emotion, memory, and autonomic functions. This condition presents with a unique combination of neurological and psychiatric symptoms, making it difficult to diagnose due to its subtle manifestation and overlap with psychiatric disorders and other focal seizures. Although rare, accurate recognition of cingulate epilepsy is crucial, as misdiagnosis can lead to ineffective psychiatric treatment, delays in epilepsy management, and a reduced quality of life for patients. We present two case reports along with a literature review to highlight the clinical significance of cingulate epilepsy, the challenges in diagnosis, and the implications for treatment in neuropsychiatry.
Methods
We present two patients diagnosed with cingulate epilepsy at a tertiary epilepsy centre. Each case was diagnosed clinically, EEG findings, neuroimaging (MRI), and by excluding other causes of focal seizures. Additionally, a literature review was conducted to analyse the clinical features and seizure location and to examine the current understanding of cingulate epilepsy, focusing on the intersection of neurology and psychiatry. Relevant studies from 1991 to 2017 were included, using PubMed and other medical databases.
Case Reports • Case 1: A right-handed 44-year-old male presented with shoulder movement, irregular jerking of the limbs, and giggling or muffled laughter. Video EEG telemetry captures 10 seizures of brief hyper motor movements on the left and face covering with slowing over the left frontocentral region. An MRI brain showed possible left sided cortical dysplasia within the anterior cingulate gyrus.
• Case 2: A right-handed 24-year-old male had his first seizure at 21 and underwent assessment for epilepsy surgery. MRI brain showed left posterior-medial frontal cingulate lesion, likely a low-grade glioma.
Literature Review
The literature review identified 12 relevant studies, providing insight into the diverse clinical manifestations of cingulate epilepsy. Common symptoms include autonomic dysfunction, emotional disturbances, and changes in consciousness, often misinterpreted as psychiatric symptoms. EEG findings typically show focal spikes or sharp waves at the cingulate region. Functional imaging, including PET and SPECT scans, have proven helpful in localizing seizure foci when conventional imaging is inconclusive. Surgical interventions, including focal resection, have shown promising results in select cases, particularly when seizures are refractory to pharmacological treatment.
Conclusion
In conclusion, while cingulate epilepsy is rare its distinct combination of autonomic, neurological, and psychiatric symptoms underscores the importance of early recognition and a multidisciplinary approach for effective management and improved patient outcomes. Diagnosis relies on detailed clinical history, EEG monitoring, and advanced neuroimaging. While treatment options are limited, patients with refractory seizures may benefit from surgical options such as resective epilepsy surgery and deep brain stimulation. This case series highlights the importance of considering cingulate epilepsy in unexplained psychiatric presentations, as early intervention can significantly improve outcomes. Further research is essential to better understand its pathophysiology and optimize management strategies.
Description
Citation
Journal of Neurology, Neurosurgery & Psychiatry 2025;96:A15-A16.
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License
Journal
Journal of Neurology, Neurosurgery & Psychiatry
Volume
96
Issue
Issue Suppl 2