Investigators from the Cleveland Clinic, and University of Texas Southwestern Medical Center, studied consecutive cases of cingulate gyrus epilepsy identified retrospectively from their epilepsy databases from 1992 to 2009. Of 14 patients with cingulate epilepsy confirmed by MRI and response to lesionectomy, 4 with lesions in the posterior cingulate location had electroclinical findings suggestive of a temporal origin of the epilepsy. Of 10 anterior cingulate cases, 6 in a typical (Bancaud) group had hypermotor/hyperkinetic seizures, rarely generalized, with fear, laughter, or severe interictal personality changes, and 4 were atypical, with simple motor seizures, frequently generalized, and a less favorable long-term surgical outcome. All atypical cases were associated with an underlying infiltrative astrocytoma. Posterior cingulate gyrus epilepsy is regarded as a pseudotemporal epilepsy. 
COMMENT. Surface EEG is often inaccurate in localizing a deep-seated epileptogenic zone in a patient with cingulate epilepsy. Symptoms of cingulate epilepsy are heterogeneous and dependent on an anterior or posterior localization of the lesion. Anterior lesions are associated with hyperkinetic behavior, cycling and running and gelastic seizures, expressed by mirthless laughter. Posterior cingulate seizures resemble temporal lobe epilepsy. This report emphasizes the importance of an MRI-identifiable lesion in the diagnosis of cingulate epilepsy.