Laughter Gelastic Seizure

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Gelastic seizure is a rare type of epilepsy which is also known as Gelastic Epilepsy. Gelastic seizure is defined as sudden occurrence of emotions in the form of a laugh or a cry. The name gelastic epilepsy comes from Greek word 'gelos' which means laughter. Time of seizure is generally 5 to 60 seconds. Percentage of occurrence is slightly higher in male than female. Previously it is considered that gelastic seizures are originated in the temporal lobes but further study described that it is associated with hypothalamic hamartomas. It is affected to any age group but mostly before three or four years of age. In most of the cases gelastic seizures is followed by tonic-clonic seizures and atonic seizures.

Laughing seizures were first described by Trousseau (1877). Trousseau described a patient that had a seizure in a regular clinic visit characterized by vertigo and jerking bursts of laughter. When Trousseau asked the patient why he laughed, the patient was surprised with the question because he was not aware during the spell. Trousseau used the term epileptic vertigo for any 'transient strange phenomena – giddiness, astonishment, ecstasy … fit of absence.

Causes of Gelastic seizure

1. A common cause of gelastic epilepsy is a small tumour in the hypothalamus. This tumour may be either a hamartoma or an astrocytoma.
   
2. Focal cortical dysplasias also give rise to gelastic seizure and difficultly noted in EEG.
   
3. Person having family history of migraines may have chances for gelastic seizures.
   
4. Temporal or frontal lobe lesions.

Signs and Symptoms of Gelastic seizure

• Sudden occurrence of laughing or crying without any obvious cause.
  
• Twitching, eye or head movements, automatisms such as lip smacking, speechless, chewing or grinding the teeth.
  
• If seizure is associated with hypothalamic hamartomas then seizure start during infancy and occurrence is very frequent
  
• Child may become confuse during or after seizure.
  
• Learning inability and behavioral problems
  
• Development of secondary sex characteristics before the age of eight is shown by girls having gelastic seizures.
• The gelastic and other types of seizures are often very difficult to control.
  

Diagnosis for Gelastic seizure

In most of the cases gelastic seizures is diagnosis very lately because symptoms are like normal events.

1. Computed tomography (CT) and magnetic resonance imaging (MRI) are very widely used to look for the tumors in diagnosis of gelastic seizures.
   
2. Photon emission computed tomography may also be used
   
3. Video of the child's seizure also helpful in diagnosis.
   
4. Electroencephalogram (EEG) shows sharp waves, spikes or spike and slow waves or interictal epileptic discharges.
   Person having gelastic seizures shows during EEG.

What is treatment for Gelastic seizure?

• Anti-epileptic drugs such as topamax, carbamazepine, levetiracetam, clobazam, lamictal and oxcarbazepine are used.
  
• Combination of dextroamphetamine, primidone and phenobarbital is preferred.
  
• Surgical treatment or radiotherapy is used if cause of seizure is tumor. In this tumor is removed which gives improvement in learning abilities.
  
• Treatment with hormones is given to child who is having fast puberty.

Epilepsy medications used to treat focal (partial) seizures might also be effective in the treatment of gelastic epilepsy. The medications include:

Clobazam
Topiramate
Lamotrigine
Levetiracetam
Oxcarbazepine
Carbamazepine