Gelastic seizures – case presentation and review of the literature
Keywords:
gelastic seizures, hypothalamic hamartoma, symptomatic epilepsyAbstract
Gelastic seizures are a rare type of seizures in which laughter is the main ictal manifestation. They are mostly seen in patients with hypothalamic hamartomas and in some of those cases they are combined with premature puberty.
We present two cases of patients with gelastic seizures – with hypothalamic hamartoma and with pilocytic astrocytoma. The first case is of an 8-year-old boy diagnosed with central precocious puberty at the age of 3, when magnetic resonance imaging (MRI) showed hypothalamic hamartoma. From the age of 7 years the child has been experiencing epileptic seizures with the characteristic of gelastic – he smiles, laughs, with loss of consciousness for a few seconds, during which he becomes pale and performs stereotyped movements with his head. The patient also reports 3 secondary generalized tonic-clonic seizures. In another patient – 5-year-old girl, seizures with ictal laughter and tonic deviation of the month to the left were described. EEG showed epileptiform and slow-wave changes in the right centro-parietal region. A cystic formation in the right frontal lobe with a mass effect on the surrounding structures was found on computed tomography.
In the presence of gelastic seizures MRI should be performed to look for hypothalamic hamartoma. Less commonly such seizures have been reported in symptomatic frontal and temporal lobe epilepsy, as well as in cryptogenic cases.
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Copyright (c) 2020 Iliyana Aleksandrova, E. Slavkova, D. Deneva, N. Topalov, V. Bojinova
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