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Clinical Cases and Reviews in Epilepsy

Multimodal functions of the parietal lobe: review of the literature and insights from cortical stimulation in epilepsy

Review, 14 - 19
doi: 10.11138/ccre/2016.1.1.014
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Abstract
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Objective: intracerebral electrical cortical stimulation (ECS) is a very important tool to assess the functional role of a given cortical region, and thus guide neurosurgical interventions. While the physiology of the anterior and lateral parietal cortex, with their roles in the primary and secondary level of processing sensory stimuli, respectively, have been well established, the multiple and complex functions of the posterior parietal cortex have not been completely understood. ECS allows obtaining a cortical map of human cortical functions and defining the eloquent areas. While it has been used to map primary sensory, secondary sensory and supplementary sensorimotor areas, the posterior parietal areas have not been extensively studied.
Methods: we present narrative review of the physiology of the parietal lobes and comment on the results of our recent stereo-electroencephalography study on the multimodal responses induced by ECS of the parietal lobe (24), in which we analysed the clinical effects associated with ECS of the various parietal substructures.
Results: we obtained prevalent sensory and motor symptoms in the postcentral gyrus and in the parietal operculum. Dysarthria was also mostly evoked in the parietal operculum. Visual illusion and hallucinations, eyeball/eyelid movements or sensations, and vertigo were the most frequent responses elicited in the precuneus. Visual illusion and hallucinations were also the prevalent responses obtained from ECS of the intraparietal sulcus. Heterogeneous and multimodal responses were found in the posterior cingulum, superior and inferior parietal lobule, supporting their highly integrative functions.
Conclusions: we conclude that the functional organisation of the parietal cortex is complex and implies cognitive functions and a high level of multimodal integration. This deserves further, more detailed investigation..

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