ABSTRACT
Gelastic epilepsy or laughing seizures have been historically related to children with hypothalamic hamartomas. We report three adult patients who had gelastic epilepsy, defined as the presence of seizures with a prominent laugh component, including brain imaging, surface/invasive electroencephalography, positron emission tomography, and medical/surgical outcomes. None of the patients had hamartoma or other hypothalamic lesion. Two patients were classified as having refractory epilepsy (one had biopsy-proven neurocysticercosis and the other one hippocampal sclerosis and temporal cortical dysplasia). The third patient had no lesion on MRI and had complete control with carbamazepine. Both lesional patients underwent resective surgery, one with complete seizure control and the other one with poor outcome. Although hypothalamic hamartomas should always be ruled out in patients with gelastic epilepsy, laughing seizures can also arise from frontal and temporal lobe foci, which can be surgically removed. In addition, we present the first case of gelastic epilepsy due to neurocysticercosis.
ABSTRACT
INTRODUCTION: Epilepsy prevalence is 0.27-1.7% in general population. However, higher figures have been reported in Multiple Sclerosis (MS) patients, suggesting this association is not coincidental. METHODS: We retrospectively reviewed the records of MS patients seen between 2009 and 2012 at Pontificia Universidad Católica of Chile's Multiple Sclerosis Center. RESULTS: Of 310 MS patients, ten had the diagnosis of epilepsy (3.2%). These patients were younger, and had an earlier onset of symptoms of MS compared to the group without epilepsy (32 vs. 40 years, p=0.04 and 25 vs. 32 years, p=0.02, respectively). In 4 patients, seizures were the first MS symptom and the most frequent seizure type was partial secondary generalized (6 patients). MRI showed cortical lesions in all patients. Patients with poor epilepsy control (frequent seizures or development of status epilepticus) had lower brain volumes and worse cognitive performance. All patients received antiepileptic drugs as well as immunomodulatory therapy. CONCLUSION: Patients with epilepsy and MS are younger and have an earlier onset of symptoms. Since most seizures were partial, the presence of cortical lesions and progressive brain atrophy could probably be the pathophysiological mechanism underlying this association.
