{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:51:43Z","timestamp":1792155103439,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n Sleep\u2010related hypermotor epilepsy (SHE) is classically considered a frontal lobe epilepsy; however, accumulating evidence suggests that hypermotor seizures may arise from multiple frontal and extrafrontal regions. We characterized the anatomical distribution of best available localizations in patients with SHE using multimodal presurgical data.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively analyzed 17 patients with clinically diagnosed SHE who underwent comprehensive evaluation, including long\u2010term video\u2010electroencephalographic (EEG) monitoring, 3\u2010T high\u2010resolution magnetic resonance imaging (MRI), 18F\u2010fluorodeoxyglucose positron emission tomography, and, where indicated, magnetoencephalography, stereo\u2010EEG (SEEG), and surgical assessment. Best available anatomical localizations were assigned using a hierarchical multimodal framework incorporating surgical, SEEG, and concordant noninvasive findings. Their anatomical distribution was subsequently assessed at the cohort level.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Sixteen patients (94.1%) had an assigned best available localization. Cingulate or insulo\u2010opercular regions were involved in 11 of 16 patients (68.8%), whereas the remaining cases were localized to other frontal regions. In a sensitivity analysis restricted to 10 patients with SEEG\u2010defined and\/or surgically supported localizations, six involved cingulate or insulo\u2010opercular regions. All patients were MRI\u2010negative. In contrast, MRI\u2013positron emission tomography fusion provided regionally informative anatomical findings in 16 of 17 cases and contributed to multimodal localization. Interictal epileptiform discharges were identified in 15 patients, whereas regionally informative ictal scalp EEG patterns were observed in eight; ictal interpretation was frequently limited by rapid propagation, movement\u2010related artifacts, and delayed EEG onset. Focal cortical dysplasia\u2010related histopathological findings were identified in five of seven resected specimens, whereas interpretation in two was limited by prior thermocoagulation.<\/jats:p>\n <\/jats:sec>\n \n Significance<\/jats:title>\n These descriptive findings indicate that cingulate and insulo\u2010opercular regions were frequently represented among the identified localizations in this presurgical cohort. Multimodal evaluation integrating electroclinical, imaging, and invasive findings may support presurgical localization in MRI\u2010negative SHE.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/epi.70548","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:18:33Z","timestamp":1792153113000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Frequent involvement of cingulate and insulo\u2010opercular regions in sleep\u2010related hypermotor epilepsy: A multimodal presurgical study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9390-1568","authenticated-orcid":false,"given":"Fei","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"Research Department of Epilepsy, Queen Square Institute of Neurology University College London London UK"},{"name":"Department of Epilepsy National Hospital for Neurology & Neurosurgery London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5403-6097","authenticated-orcid":false,"given":"Xiao\u2010rui","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2946-4036","authenticated-orcid":false,"given":"Shi\u2010wen","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1330-3628","authenticated-orcid":false,"given":"Luisa","family":"Delazer","sequence":"additional","affiliation":[{"name":"Research Department of Epilepsy, Queen Square Institute of Neurology University College London London UK"},{"name":"Department of Epilepsy National Hospital for Neurology & Neurosurgery London UK"},{"name":"Department of Neurology Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0363-3033","authenticated-orcid":false,"given":"Nicholas","family":"Fearns","sequence":"additional","affiliation":[{"name":"Research Department of Epilepsy, Queen Square Institute of Neurology University College London London UK"},{"name":"Department of Epilepsy National Hospital for Neurology & Neurosurgery London UK"},{"name":"Department of Neurology, Epilepsy Center Ludwig Maximilian University Hospital, Ludwig\u2010Maximilians\u2010Universit\u00e4t M\u00fcnchen Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9210-2092","authenticated-orcid":false,"given":"Thaera","family":"Arafat","sequence":"additional","affiliation":[{"name":"Research Department of Epilepsy, Queen Square Institute of Neurology University College London London UK"},{"name":"Department of Epilepsy National Hospital for Neurology & Neurosurgery London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9927-847X","authenticated-orcid":false,"given":"Rui\u2010juan","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4068-9928","authenticated-orcid":false,"given":"Wen\u2010han","family":"Hu","sequence":"additional","affiliation":[{"name":"Beijing Neurosurgical Institute Capital Medical University Beijing China"},{"name":"Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9989-6462","authenticated-orcid":false,"given":"Chao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4277-8000","authenticated-orcid":false,"given":"Matthias","family":"Koepp","sequence":"additional","affiliation":[{"name":"Research Department of Epilepsy, Queen Square Institute of Neurology University College London London UK"},{"name":"Department of Epilepsy National Hospital for Neurology & Neurosurgery London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5946-2918","authenticated-orcid":false,"given":"Qun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"National Center for Clinical Medicine of Neurological Diseases Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"19","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1212\/WNL.0000000000002666","article-title":"Definition and diagnostic criteria of sleep\u2010related hypermotor epilepsy","volume":"86","author":"Tinuper P","year":"2016","journal-title":"Neurology"},{"key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.2147\/NSS.S152624","article-title":"Sleep\u2010related hypermotor epilepsy: prevalence, impact and management strategies","volume":"10","author":"Menghi V","year":"2018","journal-title":"Nat Sci Sleep"},{"key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.2147\/NSS.S330986","article-title":"Sleep\u2010related hypermotor epilepsy: etiology, 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