Gelastic epilepsy is a form of epilepsy in which a person's seizures are, 'gelastic.' The Greek word, 'Gelastikos,' means laughter. Gelastic epilepsy is somewhat more common in boys than it is in girls. The form of epilepsy is; however, very rare and out of every 1,000 children who experience a form of epilepsy, only 1 or 2 will experience gelastic epilepsy. The most common areas of a person's brain which give rise to gelastic seizures are the hypothalamus, a small yet highly important structure deep in the center of the brain, as well as the frontal lobes and temporal lobes.
A gelastic seizure, also known as "gelastic epilepsy" is a rare type of seizure that involves a sudden burst of energy, usually in the form of laughing or crying. This syndrome usually occurs for no obvious reason and is uncontrollable. It is slightly more common in males than females. The main sign of a gelastic seizure is a sudden outburst of laughter or crying with no apparent cause.
A common cause of gelastic epilepsy is a small tumor in a person's hypothalamus. The tumor might be either a, 'hamartoma,' or an, 'astrocytoma.' A hamartoma is benign, meaning it is non-cancerous, and is made up of an abnormal mixture of cells and tissues usually found in the area of a person's body where growth happens. An astrocytoma is a nervous system tumor that grows from, 'astrocytes.' Astrocytomas are a type of glial cell. Glial cells are the supporting cells of a person's nervous system.
Fortunately, most of these tumors are benign. What this means is they may grow very slowly and do not spread to other portions of a person's body or brain. If a child has gelastic seizures and, 'precocious puberty,' which means they go into puberty very early - usually before the age of 10, then it is likely that they will be found to have a, 'hypothalamic hamartoma,' or a hamartoma in the hypothalamus part of their brain. It is common for older children who have gelastic epilepsy caused by a hypothalamic hamartoma to also experience behavioral and learning issues, which usually worsen in the child's mid-to-late teenage years.
Symptoms of Gelastic Epilepsy
A person may experience seizures at any age, although usually prior to 3-4 years of age. The seizures usually begin with laughter. The laughter is many times described as being, 'empty,' or, 'hollow,' and not pleasant. The laughter happens rather suddenly, comes on for no apparent reason, and is usually entirely out of place. At times, older children might complain of a warning or aura beforehand, although they are not always able to describe exactly what the warning is like.
The laughter commonly lasts less than a minute and is followed by signs that are more usually recognized with focal seizures. The signs may include:
|Signs More Usually Recognized with Focal Seizures|
|Eye and head movement to one side or the other|
|'Automatisms,' such as mumbling, lip-smacking, or hand fidgeting|
The signs may last for a period of seconds to as long as a number of minutes and then cease. Children might also have other types of seizures, either right after these gelastic seizures, or at other times. The seizures may include atonic or tonic-clonic seizures.
Diagnosing Gelastic Seizures
A detailed history or description of the person's episodes needs to be taken from someone who has actually witnessed them. The episodes of laughter may be confused with emotional or behavioral disorders and this might delay achievement of a diagnosis, something that is especially likely to occur in younger children. At times, a video of the child's episodes may be very helpful.
The person's electroencephalogram (EEG) may show generalized or focal abnormalities such as sharp waves, spikes, or spike and slow waves. A magnetic resonance imaging (MRI) scan of the person's brain should be performed to look for the tumors that might be found in the hypothalamus in some children who experience gelastic epilepsy. An MRI scan is more powerful than a computed tomography (CT) brain scan and is therefore more likely to reveal even very small tumors.
Treating Gelastic Epilepsy
Epilepsy medications used to treat focal (partial) seizures might also be effective in the treatment of gelastic epilepsy. The medications include:
Sadly, no epilepsy medications are likely to stop all seizures from occurring. Surgery, or a certain form of radiotherapy, may be possible if a tumor in the person's hypothalamus - or less commonly in their frontal or temporal lobes, is found to be causing their gelastic seizures. The treatments are available through specialists.
If a child also has precocious puberty, this may be treated with hormones, or hormone-like medications. Unfortunately, the behavioral and learning issues rarely respond to medical treatment. They might; however, improve after surgical or radiotherapy treatment if the cause is due to a hamartoma.
Gelastic and other types of seizures are often times very hard to control. It is rare for anyone to have their seizures controlled for more than a few weeks or months at a time. The best outcome is most likely experienced by children and adults who have a benign tumor in their hypothalamus, the hamartoma or astrocytoma, which is causing their epilepsy. Successful surgery in these people might improve not only their seizure control, but also improve their behavioral and learning issues.
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