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Review
. 2021 Apr 1;23(2):218-227.
doi: 10.1684/epd.2021.1257.

The precuneal cortex: anatomy and seizure semiology

Ruba R Al-Ramadhani  1 , Veeresh Kumar N Shivamurthy  1 , Kathryn Elkins  1 , Satyanarayana Gedela  2 , Nigel P Pedersen  3 , Ammar Kheder  4
Affiliations
Review

The precuneal cortex: anatomy and seizure semiology

Ruba R Al-Ramadhani et al. Epileptic Disord. .

Abstract

The purpose of this review is to describe the functional anatomy of the precuneal cortex and outline some semiological features of precuneal seizures. The precuneal cortex is a structure that occupies the posterior medial portion of the parietal lobe, and it has broad cortical and subcortical connections. Neuroanatomical tracing, functional imaging, as well as electrical stimulation studies of humans and other primates have elucidated many complex integrative functions of the precuneus including visuo-spatial imagery, sensorimotor functions, and consciousness. Based on the understanding of its functions and connectivity, descriptions of potential seizure semiologies are hypothesized and compared to what is available in the literature. The latter is mostly in the form of case reports or case series. Seizures may involve simple or complex motor or sensory manifestations including abnormal eye movements, visual hallucinations, sensation of motion, or medial temporal-like seizures.

Keywords: SEEG; epilepsy surgery; focal epilepsies; parietal lobe; parietal lobe epilepsy; precuneus.

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Conflict of interest statement

Disclosure of Conflicts of Interest

NPP is a member of the Scientific Advisory Board for Dixi Medical USA.

Figures

Figure 1.
Figure 1.. Cytoarchitectonic parcellation of the precuneus.
Parcellations that are commonly used in epilepsy literature of (a) Brodmann (1909) and (b) von Economo and Koskinas (1925). Note that the margins of the precuneus extend below the shaded area to include the dorsal part of Brodmann’s area (BA) 31. In the primate, the central precuneus is termed PGm given strong homology with von Economo and Koskinas’s region PG. From (Caspers et al. 2012) with permission
Figure 2.
Figure 2.. Functional regions of the precuneus and their connections.
The four functional subdivisions of the precuneus are depicted: The sensorimotor (blue), cognitive (green), visual (yellow) and limbic (red). Basic connections are depicted. ACC: Anterior cingulate cortex/region. IPL: Inferior parietal lobule. IPS: Intraparietal sulcus. M1: Primary motor cortex. PHG: Parahippocampal gyrus. SMA: Supplementary motor area. SPL: Superior parietal lobule. STG: Superior temporal gyrus.
See this image and copyright information in PMC

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