Prognosis and influencing factors of surgical treatment in patients with cingulate epilepsy

Objective To report the clinical characters, surgical treatment and outcomes of patients with cingulate epilepsy (CE). Methods We retrospectively analyzed the clinical data of 37 CE patients who underwent resective operations at Department of Neurosurgery, the First Affiliated Hospital of PLA General Hospital from January 2003 to October 2016 and performed statistical study of seizure symptoms in different types of CE, surgical approaches and outcomes. In addition, the influencing factors were analyzed for patients who were postoperative seizure free. Results The semiology of CE varied. Hypermotor and fear were common symptoms in anterior CE and asymmetrical tonic seizure was more common in middle-posterior CE. However, visual and hallucinatory symptoms were exclusively reported in posterior CE. All 37 patients underwent resected surgery, including 23 cases of pathological focus resection, 11 cases of cerebral lobe and cingulate gyrus (including pathological focus) resection, and 3 cases of epileptogenic zonectomy. Scalp EEG of 12 (32.4%) patients was unable to provide lateralization and localization information for epileptogenic zone. The percentage of postoperative seizure free was 83.8%(31/37) at 1-year follow-up. Univariate analysis showed that MRI results, locations of epileptic foci or pathological lesions in the cingulate gyrus, natures of pathological lesions, and results of scalp EEG were not significantly correlated with seizure-free after surgery(P>0.05). Multivariate logistic regression analysis showed that patients with higher intelligence quotient(IQ) before surgery had better surgical outcomes(OR=15.94, 95%CI: 1.081~234.869, P=0.044). Conclusions The semiology of CE vary greatly and the scalp EEG can provide limited information for epileptogenic zone localization. Resective operation is an effective approach in the treatment of CE and high preoperative IQ may be a positive predictor for postoperative seizure-free. Key words: Epilepsy; Gyrus cinguli; Neurosurgical procedures; Root cause analysis