All rights reserved This article has been cited by other articles in PMC. Abstract Gelastic seizures are epileptic events characterized by bouts of laughter. Laughter-like vocalization is usually combined with facial contraction in the form of a smile. Autonomic features such as flushing, tachycardia, and altered respiration are widely recognized. Conscious state may not be impaired, although this is often difficult to asses particularly in young children. Gelastic seizures have been associated classically to hypothalamic hamartomas, although different extrahypothalamic localizations have been described.
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Gelastic Epilepsy What is Gelastic Epilepsy? A gelastic seizure is defined as sudden occurrence of emotions in the form of a laugh or a cry. Usually the seizure lasts around 5 to 60 seconds. In most cases gelastic seizures are associated with other seizure types. There are a wide range of causes for gelastic seizures, and neuroimaging investigations MRI are often required to delineate the cause.
A very common cause of gelastic epilepsy is a small tumour in the hypothalamus area of the brain. These tumours may be either a hamartoma or an astrocytoma. The majority of these tumours are benign which means that they may grow only very slowly and do not spread to other parts of the brain or body. If the child has gelastic seizures and precocious puberty which means that they go into puberty very early, usually under 10 years of age , then it is likely that the child will be found to have a hypothalamic hamartoma a hamartoma in the hypothalamus part of the brain.
If the child also has precocious puberty, then this can be treated with hormones or hormone-like medicines. The anti-epileptic drugs AEDs used to treat focal seizures may also be effective in treating gelastic epilepsy. These include carbamazepine Tegretol , clobazam Frisium , lamotrigine Lamictal , levetiracetam Keppra , oxcarbazepine Trileptal and topiramate Topamax , amongst others. Unfortunately none of these medications or any other AEDs are likely to stop all seizures from happening when associated with hypothalamic hamartoma, and it is rare for anyone to have their seizures controlled for more than a few weeks or months at a time.
Epilepsy and Gelastic Epilepsy Seizures may begin at any age but in the setting of hypothalamic Hamartoma usually before three or four years of age. The laughter occurs suddenly, comes on for no obvious reason and is usually completely out of place.
The laughter usually lasts less than one minute and is then followed by signs that are more usually recognised with focal dyscognitive seizures. These signs can include eye and head moving to one or the other side, automatisms such as lip-smacking, mumbling or fidgeting of the hands and altered awareness.
This period may last for seconds to many minutes and then stops. People with Gelastic Epilepsy may also have other types of seizures either immediately after these gelastic seizures or at other times. These include tonic clonic and atonic seizures also known as drop seizures. Educational Implications for Children It is common for older children who have gelastic epilepsy caused by a hypothalamic hamartoma, to also have learning and behavioural problems and these usually get worse in the mid to late teenage years.
Unfortunately, the learning and behavioural problems rarely respond to medical treatment, but may improve after surgical treatment if the cause is due to a hamartoma. Dr Stewart Macleod, Specialist Registrar in paediatric neurology. Updated August To be reviewed August
See also: Pseudobulbar affect The main sign of a gelastic seizure is a sudden outburst of laughter or crying with no apparent cause. The outburst usually lasts for less than a minute. During or shortly after a seizure, an individual might display some twitching, strange eye movements, lip smacking, fidgeting or mumbling. If a person who suffers from the seizures is hooked up to an electroencephalogram , it will reveal interictal epileptic discharges. This syndrome usually manifests itself before the individual reaches the age of three or four. The temporal lobes, and the hypothalamus are the areas of the brain with the most involvement with these seizures. This may cause learning disabilities , and faulted cognitive function as well.
Gelastic and Dacrystic Seizures