Precuneus- anatomy, function and epilepsy_Journal of Epilepsy

Authors：

FAN Zhenyu ,  WANG Tiancheng

Department of Neurology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730000, China;

Corresponding?author：

WANG Tiancheng, Email: 814984027@qq.com

Keywords：

Precuneus; Epilepsy; Precuneus epilepsy

DOI：

10.7507/2096-0247.202604013

Video：

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The precuneus is located on the posteromedial side of the parietal lobe and has extensive cortical and subcortical connections. Functional imaging studies have shown that the precuneus has four subregions with different functional connectivity patterns: the anterior sensorimotor area, the central cognitive area, the posterior visual area, and the ventral limbic area. The precuneus plays a core role in a series of highly integrated tasks, including visual-spatial processing, sensorimotor functions, episodic memory, self-processing, and consciousness. Its importance in complex cognitive functions is related to the three brain networks it participates in: the default mode network (DMN) core, the DMN episodic memory subnetwork, and the para-cingulate network. Vestibular reactions, visual symptoms, and body image disturbances are the main non-motor symptoms of precuneus epilepsy, while postural tonic and hypermotor are the main motor symptoms of its seizures. The differences in clinical features may be related to the specific location of the epileptogenic zone in the precuneus and the diffusion pattern of epileptic seizures. Precuneus epilepsy is mostly drug-resistant epilepsy, and the value of scalp EEG localization is limited, so surgical treatment is an effective option.

Citation： FAN Zhenyu, WANG Tiancheng. Precuneus- anatomy, function and epilepsy. Journal of Epilepsy, 2026, 12(4): 326-330. doi: 10.7507/2096-0247.202604013 Copy

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2.	Raichle ME. The brain's default mode network. Annu Rev Neurosci, 2015, 38: 433-447.
3.	Utevsky AV, Smith DV, Huettel SA. Precuneus is a functional core of the default-mode network. J Neurosci, 2014, 36(47): 12066-12068.
4.	Gusnard DA, Raichle ME. Searching for a baseline: functional imaging and the resting human brain. Nat Rev Neurosci, 2001, 2(10): 685-694.
5.	Horvath A, Kiss M, Szucs A, et al. Precuneus-dominant degeneration of parietal lobe is at risk of epilepsy in mild Alzheimer's disease. Front Neurol, 2019, 10: 878.
6.	Messina A, Cuccì G, Crescimanno C, et al. Clinical anatomy of the precuneus and pathogenesis of the schizophrenia. Anatomical Science International, 2023, 98(4): 473-481.
7.	Pereira-Pedro A , Bruner E. Sulcal pattern, extension, and morphology of the precuneus in adult humans. Annals of Anatomy - Anatomischer Anzeiger, 2016, 208: 85-93.
8.	Harroud A, Boucher O, Tran TPY, et al. Precuneal epilepsy: clinical features and surgical outcome. Epilepsy Behav, 2017, 73: 77-82.
9.	Gürer B, Bozkurt M, Neves G, et al. The subparietal and parietooccipital sulci: an anatomical study. Clin Anat, 2013, 26(6): 667-674.
10.	Al-Ramadhani RR, Shivamurthy VKN, Elkins K, et al. The precuneal cortex: anatomy and seizure semiology. Epileptic Disord, 2021, 23(2): 218-227.
11.	Cavanna AE. The precuneus and consciousness. CNS Spectr, 2007, 12(7): 545-552.
12.	Tanglay O, Young IM, Dadario NB, et al. Anatomy and white-matter connections of the precuneus. Brain Imaging and Behavior, 2021, 16(2): 574-586.
13.	Margulies DS, Vincent J, Kelly C, et al. Precuneus shares intrinsic functional architecture in humans and monkeys. Proc Natl Acad Sci U S A, 2009, 106(47): 20069-20074.
14.	Zhang S, Li CS. Functional connectivity mapping of the human precuneus by resting state fMRI. Neuroimage, 2012, 59(4): 3548-3562.
15.	Jitsuishi T, Yamaguchi A. Characteristic cortico-cortical connection profile of human precuneus revealed by probabilistic tractography. Sci Rep, 2023, 13(1): 1936.
16.	Vogt BA, Laureys S. Posterior cingulate, precuneal and retrosplenial cortices: cytology and components of the neural network correlates of consciousness. Prog Brain Res, 2005, 150: 205-217.
17.	Raichle ME, MacLeod AM, Snyder AZ, et al. A default mode of brain function. Proc Natl Acad Sci U S A, 2001, 98(2): 676-682.
18.	Lundstrom BN, Ingvar M, Petersson KM. The role of precuneus and left inferior frontal cortex during source memory episodic retrieval. Neuroimage, 2005, 27(4): 824-834.
19.	Addis DR, McIntosh AR, Moscovitch M, et al. Characterizing spatial and temporal features of autobiographical memory retrieval networks: a partial least squares approach. Neuroimage, 2004, 23(4): 1460-1471.
20.	Wu H, Qi Z, Wu X, et al. Anterior precuneus related to the recovery of consciousness. Neuroimage Clin, 2022, 33: 102951.
21.	Herbet G, Lemaitre AL, Moritz-Gasser S, et al. The antero-dorsal precuneal cortex supports specific aspects of bodily awareness. Brain, 2019, 142(8): 2207-2214.
22.	Lyu D, Stieger J R, Xin C, et al. Causal evidence for the processing of bodily self in the anterior precuneus. Neuron, 2023, 111(16): 2502-2512.
23.	Yeager BE, Bruss J, Duffau H, et al. Central precuneus lesions are associated with impaired executive function. Brain Struct Funct, 2022, 227(9): 3099-3108.
24.	Wang J, Becker B, Wang L, et al. Corresponding anatomical and coactivation architecture of the human precuneus showing similar connectivity patterns with macaques. Neuroimage, 2019, 200: 562-574.
25.	Yokosawa K, Kimura K, Takase R, et al. Functional decline of the precuneus associated with mild cognitive impairment: Magnetoencephalographic observations. PLoS One, 2020, 15(9): e0239577.
26.	Miners JS, Palmer JC, Love S. Pathophysiology of hypoperfusion of the precuneus in early Alzheimer's disease. Brain Pathol, 2016, 26(4): 533-541.
27.	Koch G, Casula EP, Bonnì S, et al. Precuneus magnetic stimulation for Alzheimer's disease: a randomized, sham-controlled trial. Brain, 2022, 145(11): 3776-3786.
28.	Dadario N B, Sughrue M E. The functional role of the precuneus. Brain, 2023, 146(9): 3598-3607.
29.	Mailo J, Tang-Wai R. Insight into the precuneus: a novel seizure semiology in a child with epilepsy arising from the right posterior precuneus. Epileptic Disord, 2015, 17(3): 321-327.
30.	Wiest G, Zimprich F, Prayer D, et al. Vestibular processing in human paramedian precuneus as shown by electrical cortical stimulation. Neurology, 2004, 62(3): 473-475.
31.	Gibbs SA, Figorilli M, Casaceli G, et al. Sleep related hypermotor seizures with a right parietal onset. J Clin Sleep Med, 2015, 11(8): 953-955.
32.	Bartolomei F, Gavaret M, Hewett R, et al. Neural networks underlying parietal lobe seizures: a quantified study from intracerebral recordings. Epilepsy Res, 2011, 93(2-3): 164-176.
33.	AlGaeed M, Javan R, Shields D C, et al. Temporal lobe epilepsy with a contralateral parietal seizure-onset zone. Epileptic Disord, 2021, 23(5): 787-792.
34.	Umeoka S, Baba K, Terada K, et al. Bilateral symmetric tonic posturing suggesting propagation to the supplementary motor area in a patient with precuneate cortical dysplasia. Epileptic Disord, 2007, 9(4): 443-448.
35.	Yang Y, Wang H, Zhou W, et al. Electroclinical characteristics of seizures arising from the precuneus based on stereoelectroencephalography (SEEG). BMC Neurol, 2018, 18(1): 110.
36.	Kahane P, Hoffmann D, Minotti L, et al. Reappraisal of the human vestibular cortex by cortical electrical stimulation study. Ann Neurol, 2003, 54(5): 615-624.
37.	Balestrini S, Francione S, Mai R, et al. Multimodal responses induced by cortical stimulation of the parietal lobe: a stereo-electroencephalography study. Brain, 2015, 138(Pt 9): 2596-2607.
38.	Richer F, Martinez M, Cohen H, et al. Visual motion perception from stimulation of the human medial parieto-occipital cortex. Exp Brain Res, 1991, 87(3): 649-652.
39.	Richer F, Martinez M, Robert M, et al. Stimulation of human somatosensory cortex: tactile and body displacement perceptions in medial regions. Exp Brain Res, 1993, 93(1): 173-176.
40.	Enatsu R, Bulacio J, Nair DR, et al. Posterior cingulate epilepsy: clinical and neurophysiological analysis. J Neurol Neurosurg Psychiatry, 2014, 85(1): 44-50.
41.	Baumgartner C, Flint R, Tuxhorn I, et al. Supplementary motor area seizures: propagation pathways as studied with invasive recordings. Neurology, 1996, 46(2): 508-514.
42.	Jitsuishi T, Yamaguchi A. Posterior precuneus is highly connected to medial temporal lobe revealed by tractography and white matter dissection. Neuroscience, 2021, 466: 173-185.
43.	Skandalakis GP, Komaitis S, Kalyvas A, et al. Dissecting the default mode network: direct structural evidence on the morphology and axonal connectivity of the fifth component of the cingulum bundle. J Neurosurg, 2020, 134(3): 1334-1345.
44.	Wu Y, Sun D, Wang Y, et al. Segmentation of the cingulum bundle in the human brain: a new perspective based on DSI tractography and fiber dissection study. Front Neuroanat, 2016, 10: 84.
45.	Jaafar N, Bhatt A, Eid A, et al. The temporal lobe as a symptomatogenic zone in medial parietal lobe epilepsy. Front Neurol, 2022, 13: 804128.
46.	Narasimha VL, Basavaraju R, Mangalore S, et al. Precuneus and psychiatric manifestations: Novel neurobiological formulations through lesion based connectivity mapping of psychopathology. Asian J Psychiatr, 2019, 39: 98-100.
47.	王薇薇, 吳遜. 頂葉內側——解剖、生理與癲癇. 癲癇雜志, 2022, 8(06): 550-554.

1. Cavanna AE, Trimble MR. The precuneus: a review of its functional anatomy and behavioural correlates. Brain, 2006, 129(3): 564-583.
2. Raichle ME. The brain's default mode network. Annu Rev Neurosci, 2015, 38: 433-447.
3. Utevsky AV, Smith DV, Huettel SA. Precuneus is a functional core of the default-mode network. J Neurosci, 2014, 36(47): 12066-12068.
4. Gusnard DA, Raichle ME. Searching for a baseline: functional imaging and the resting human brain. Nat Rev Neurosci, 2001, 2(10): 685-694.
5. Horvath A, Kiss M, Szucs A, et al. Precuneus-dominant degeneration of parietal lobe is at risk of epilepsy in mild Alzheimer's disease. Front Neurol, 2019, 10: 878.
6. Messina A, Cuccì G, Crescimanno C, et al. Clinical anatomy of the precuneus and pathogenesis of the schizophrenia. Anatomical Science International, 2023, 98(4): 473-481.
7. Pereira-Pedro A , Bruner E. Sulcal pattern, extension, and morphology of the precuneus in adult humans. Annals of Anatomy - Anatomischer Anzeiger, 2016, 208: 85-93.
8. Harroud A, Boucher O, Tran TPY, et al. Precuneal epilepsy: clinical features and surgical outcome. Epilepsy Behav, 2017, 73: 77-82.
9. Gürer B, Bozkurt M, Neves G, et al. The subparietal and parietooccipital sulci: an anatomical study. Clin Anat, 2013, 26(6): 667-674.
10. Al-Ramadhani RR, Shivamurthy VKN, Elkins K, et al. The precuneal cortex: anatomy and seizure semiology. Epileptic Disord, 2021, 23(2): 218-227.
11. Cavanna AE. The precuneus and consciousness. CNS Spectr, 2007, 12(7): 545-552.
12. Tanglay O, Young IM, Dadario NB, et al. Anatomy and white-matter connections of the precuneus. Brain Imaging and Behavior, 2021, 16(2): 574-586.
13. Margulies DS, Vincent J, Kelly C, et al. Precuneus shares intrinsic functional architecture in humans and monkeys. Proc Natl Acad Sci U S A, 2009, 106(47): 20069-20074.
14. Zhang S, Li CS. Functional connectivity mapping of the human precuneus by resting state fMRI. Neuroimage, 2012, 59(4): 3548-3562.
15. Jitsuishi T, Yamaguchi A. Characteristic cortico-cortical connection profile of human precuneus revealed by probabilistic tractography. Sci Rep, 2023, 13(1): 1936.
16. Vogt BA, Laureys S. Posterior cingulate, precuneal and retrosplenial cortices: cytology and components of the neural network correlates of consciousness. Prog Brain Res, 2005, 150: 205-217.
17. Raichle ME, MacLeod AM, Snyder AZ, et al. A default mode of brain function. Proc Natl Acad Sci U S A, 2001, 98(2): 676-682.
18. Lundstrom BN, Ingvar M, Petersson KM. The role of precuneus and left inferior frontal cortex during source memory episodic retrieval. Neuroimage, 2005, 27(4): 824-834.
19. Addis DR, McIntosh AR, Moscovitch M, et al. Characterizing spatial and temporal features of autobiographical memory retrieval networks: a partial least squares approach. Neuroimage, 2004, 23(4): 1460-1471.
20. Wu H, Qi Z, Wu X, et al. Anterior precuneus related to the recovery of consciousness. Neuroimage Clin, 2022, 33: 102951.
21. Herbet G, Lemaitre AL, Moritz-Gasser S, et al. The antero-dorsal precuneal cortex supports specific aspects of bodily awareness. Brain, 2019, 142(8): 2207-2214.
22. Lyu D, Stieger J R, Xin C, et al. Causal evidence for the processing of bodily self in the anterior precuneus. Neuron, 2023, 111(16): 2502-2512.
23. Yeager BE, Bruss J, Duffau H, et al. Central precuneus lesions are associated with impaired executive function. Brain Struct Funct, 2022, 227(9): 3099-3108.
24. Wang J, Becker B, Wang L, et al. Corresponding anatomical and coactivation architecture of the human precuneus showing similar connectivity patterns with macaques. Neuroimage, 2019, 200: 562-574.
25. Yokosawa K, Kimura K, Takase R, et al. Functional decline of the precuneus associated with mild cognitive impairment: Magnetoencephalographic observations. PLoS One, 2020, 15(9): e0239577.
26. Miners JS, Palmer JC, Love S. Pathophysiology of hypoperfusion of the precuneus in early Alzheimer's disease. Brain Pathol, 2016, 26(4): 533-541.
27. Koch G, Casula EP, Bonnì S, et al. Precuneus magnetic stimulation for Alzheimer's disease: a randomized, sham-controlled trial. Brain, 2022, 145(11): 3776-3786.
28. Dadario N B, Sughrue M E. The functional role of the precuneus. Brain, 2023, 146(9): 3598-3607.
29. Mailo J, Tang-Wai R. Insight into the precuneus: a novel seizure semiology in a child with epilepsy arising from the right posterior precuneus. Epileptic Disord, 2015, 17(3): 321-327.
30. Wiest G, Zimprich F, Prayer D, et al. Vestibular processing in human paramedian precuneus as shown by electrical cortical stimulation. Neurology, 2004, 62(3): 473-475.
31. Gibbs SA, Figorilli M, Casaceli G, et al. Sleep related hypermotor seizures with a right parietal onset. J Clin Sleep Med, 2015, 11(8): 953-955.
32. Bartolomei F, Gavaret M, Hewett R, et al. Neural networks underlying parietal lobe seizures: a quantified study from intracerebral recordings. Epilepsy Res, 2011, 93(2-3): 164-176.
33. AlGaeed M, Javan R, Shields D C, et al. Temporal lobe epilepsy with a contralateral parietal seizure-onset zone. Epileptic Disord, 2021, 23(5): 787-792.
34. Umeoka S, Baba K, Terada K, et al. Bilateral symmetric tonic posturing suggesting propagation to the supplementary motor area in a patient with precuneate cortical dysplasia. Epileptic Disord, 2007, 9(4): 443-448.
35. Yang Y, Wang H, Zhou W, et al. Electroclinical characteristics of seizures arising from the precuneus based on stereoelectroencephalography (SEEG). BMC Neurol, 2018, 18(1): 110.
36. Kahane P, Hoffmann D, Minotti L, et al. Reappraisal of the human vestibular cortex by cortical electrical stimulation study. Ann Neurol, 2003, 54(5): 615-624.
37. Balestrini S, Francione S, Mai R, et al. Multimodal responses induced by cortical stimulation of the parietal lobe: a stereo-electroencephalography study. Brain, 2015, 138(Pt 9): 2596-2607.
38. Richer F, Martinez M, Cohen H, et al. Visual motion perception from stimulation of the human medial parieto-occipital cortex. Exp Brain Res, 1991, 87(3): 649-652.
39. Richer F, Martinez M, Robert M, et al. Stimulation of human somatosensory cortex: tactile and body displacement perceptions in medial regions. Exp Brain Res, 1993, 93(1): 173-176.
40. Enatsu R, Bulacio J, Nair DR, et al. Posterior cingulate epilepsy: clinical and neurophysiological analysis. J Neurol Neurosurg Psychiatry, 2014, 85(1): 44-50.
41. Baumgartner C, Flint R, Tuxhorn I, et al. Supplementary motor area seizures: propagation pathways as studied with invasive recordings. Neurology, 1996, 46(2): 508-514.
42. Jitsuishi T, Yamaguchi A. Posterior precuneus is highly connected to medial temporal lobe revealed by tractography and white matter dissection. Neuroscience, 2021, 466: 173-185.
43. Skandalakis GP, Komaitis S, Kalyvas A, et al. Dissecting the default mode network: direct structural evidence on the morphology and axonal connectivity of the fifth component of the cingulum bundle. J Neurosurg, 2020, 134(3): 1334-1345.
44. Wu Y, Sun D, Wang Y, et al. Segmentation of the cingulum bundle in the human brain: a new perspective based on DSI tractography and fiber dissection study. Front Neuroanat, 2016, 10: 84.
45. Jaafar N, Bhatt A, Eid A, et al. The temporal lobe as a symptomatogenic zone in medial parietal lobe epilepsy. Front Neurol, 2022, 13: 804128.
46. Narasimha VL, Basavaraju R, Mangalore S, et al. Precuneus and psychiatric manifestations: Novel neurobiological formulations through lesion based connectivity mapping of psychopathology. Asian J Psychiatr, 2019, 39: 98-100.
47. 王薇薇, 吳遜. 頂葉內側——解剖、生理與癲癇. 癲癇雜志, 2022, 8(06): 550-554.

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Precuneus- anatomy, function and epilepsy

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