Assessments of anterior cingulate cortex in experimental animals and humans have led to unifying theories of its structural organization and contributions to mammalian behaviour. The anterior cingulate cortex forms a large region around the rostrum of the corpus callosum that is termed the anterior executive region. This region has numerous projections into motor systems, however, since these projections originate from different parts of anterior cingulate cortex and because functional studies have shown that it does not have a uniform contribution to brain functions, the anterior executive region is further subdivided into 'affect' and 'cognition' components. The affect division includes areas 25, 33 and rostral area 24, and has extensive connections with the amygdala and periaqueductal grey, and parts of it project to autonomic brainstem motor nuclei. In addition to regulating autonomic and endocrine functions, it is involved in conditioned emotional learning, vocalizations associated with expressing internal states, assessments of motivational content and assigning emotional valence to internal and external stimuli, and maternal-infant interactions. The cognition division includes caudal areas 24' and 32', the cingulate motor areas in the cingulate sulcus and nociceptive cortex. The cingulate motor areas project to the spinal cord and red nucleus and have premotor functions, while the nociceptive area is engaged in both response selection and cognitively demanding information processing. The cingulate epilepsy syndrome provides important support of experimental animal and human functional imaging studies for the role of anterior cingulate cortex in movement, affect and social behaviours. Excessive cingulate activity in cases with seizures confirmed in anterior cingulate cortex with subdural electrode recordings, can impair consciousness, alter affective state and expression, and influence skeletomotor and autonomic activity. Interictally, patients with anterior cingulate cortex epilepsy often display psychopathic or sociopathic behaviours. In other clinical examples of elevated anterior cingulate cortex activity it may contribute to tics, obsessive-compulsive behaviours, and aberrent social behaviour. Conversely, reduced cingulate activity following infarcts or surgery can contribute to behavioural disorders including akinetic mutism, diminished self-awareness and depression, motor neglect and impaired motor initiation, reduced responses to pain, and aberrent social behaviour. The role of anterior cingulate cortex in pain responsiveness is suggested by cingulumotomy results and functional imaging studies during noxious somatic stimulation. The affect division of anterior cingulate cortex modulates autonomic activity and internal emotional responses, while the cognition division is engaged in response selection associated with skeletomotor activity and responses to noxious stimuli. Overall, anterior cingulate cortex appears to play a crucial role in initiation, motivation, and goal-directed behaviours.(ABSTRACT...

Among patients with the Dravet syndrome, cannabidiol resulted in a greater reduction in convulsive-seizure frequency than placebo and was associated with higher rates of adverse events. (Funded by GW Pharmaceuticals; ClinicalTrials.gov number, NCT02091375 .).

Transcranial electric stimulation aims to stimulate the brain by applying weak electrical currents at the scalp. However, the magnitude and spatial distribution of electric fields in the human brain are unknown. We measured electric potentials intracranially in ten epilepsy patients and estimated electric fields across the entire brain by leveraging calibrated current-flow models. When stimulating at 2 mA, cortical electric fields reach 0.8 V/m, the lower limit of effectiveness in animal studies. When individual whole-head anatomy is considered, the predicted electric field magnitudes correlate with the recorded values in cortical (r = 0.86) and depth (r = 0.88) electrodes. Accurate models require adjustment of tissue conductivity values reported in the literature, but accuracy is not improved when incorporating white matter anisotropy or different skull compartments. This is the first study to validate and calibrate current-flow models with in vivo intracranial recordings in humans, providing a solid foundation to target stimulation and interpret clinical trials.DOI: http://dx.doi.org/10.7554/eLife.18834.001

Summary: Purpose:We report the development of a questionnaire to assess health-related quality-of-life (HRQOL) in people with epilepsy and the process of cross-cultural translations of the questionnaire.Methods: A sample of 304 adults with epilepsy from 25 seizure clinics in the United States was used to derive an abbreviated questionnaire focusing on epilepsy-related issues from a longer, 89-item instrument (QOLIE-89). A rigorous forward-backward-forward system was used for cross-cultural translation.Results: A 3 1 -item questionnaire (QOLIE-3 1, version 1 .O) resulted, comprising seven subscales covering general and epilepsy-specific domains. Subscale and total scores can be calculated. The subscales were grouped into two factors: EmotionallPsychological Effects (seizure worry, overall QOL, emotional well-being, energy/fatigue subscales) and Medical/Social Effects (medication effects, work-driving-social limits, cognitive function subscales). Cross-cultural translations were made from US.-English into Danish, Dutch, German, Canadian French, French, Italian, Spanish, Swedish, and U.K. English The individual patient's perspective has become an integral aspect of health care assessment (1). In epilepsy, clinicians are careful to obtain a social history along with physical and neurological examinations and medical history. The chronic nature of epilepsy, like that of most neurological disorders, often results in long-term relationships among the neurologist, the patient, and the patient's family. However, with recent changes in medical care delivery, less time is available to learn about the impact of the disorder on the patient's life. At the same time, the concept of quality of life (QOL) assessment has led to development of generic and disease-specific questionnaires to evaluate areas of concern to patients (2).The purpose of addressing QOL include improving the quality of patient care, differentiating among treatment Accepted July 17, 1997. options, and evaluating the allocation of health care resources. The major domains of QOL are physical, psychological, and social issues (3). These areas go well beyond the traditional assessment of seizure frequency and severity, and adverse effects of medications, toward an understanding of the impact of epilepsy on daily life (1).A variety of approaches have been used to assess QOL issues for people with epilepsy (2). Unified questionnaires [e.g., QOLIE-89 (4), ESI-55 ( 5 ) ] and batteries of tests [e.g., Liverpool QOL Battery (6)] have been used for detailed research programs. However, to conduct multinational epilepsy studies that include assessments of QOL requires an instrument that has been rigorously translated and adapted to the culture of each country in which it will be used. Such instruments will allow researchers to compile and aggregate QOL data across sample populations from different countries. The process is complicated not only by the wide differences in the concept of what constitutes "health" among cultures, 81

Treatment of depression may be inadequately prioritized in the management of intractable epilepsy.