SEEG in posterior cingulate epilepsy. A 14-year-old, left-handed girl with drug-resistant epilepsy experienced epigastric sensations associated with a gustatory illusion, sometimes followed by a loss of consciousness and oro-alimentary automatisms. Speech was preserved during seizures. A focal lesion in the left thalamus, supposedly the result of a perinatal vascular event, was visible on MRI. FDG-PET showed clear left temporal hypometabolism. Interictal spikes were preferentially observed in the left temporal region. The typical ictal pattern involved rhythmic theta activity that was more posteriorly located, involving posterior temporal and centro-parietal regions. (A) Because of atypical findings on scalp EEG, and with no obvious lesion on MRI, an implantation with SEEG electrodes was proposed for this patient. An SEEG study was performed to investigate the left temporal and basal temporal regions, as well as the parietal and insulo-opercular cortex. During the seizure, SEEG revealed a low-voltage fast activity involving the parietal cingulate gyrus, which preceded the mesio-temporal discharge. SEEG implantation was performed; left-sided electrode contacts are shown on MRI and on the SEEG trace. Epileptic activity starts on the PCG (posterior cingulate gyrus) contact (red contact 1) and propagates to mesial temporal structures (NA: amygdala [green contact 1]; aHc: anterior hippocampus [green contact 2]; pHc: posterior hippocampus [green contact 3]). (B) The seizure onset zone was confirmed by epileptogenicity mapping, illustrating an important network involvement with rapid propagation to the mesial temporal region. (C) A very restricted parietal cingulate resection was performed. Neuropathology showed non-specific gliosis. The patient has been seizure-free since surgery (Engel IA with a follow-up of 33 months).