EPILEPSY WITH GELASTIC SEIZURES AND HYPOTHALAMIC HAMARTOMA: A RARE CLINICAL CASE
Abstract
Among the various types of epileptic syndromes, gelastic seizures are considered the rarest one. The condition is characterized by forced laughter and the finding of hypothalamic hamartoma. Gelastic seizures may be associated with temporal or frontal foci of epilepsy, tumors, tuberous sclerosis, hemangiomas, and infectious lesions, including hypothalamic hamartoma. The tissue of a hypothalamic hamartoma is, by its nature, an epileptogenic zone. In the presence of a hypothalamic hamartoma, the expression of neuropeptides is often disturbed, which can contribute to the development of a seizure attack. Episodes of forced laughter in patients with hypothalamic hamartomas can be combined with various vegetative manifestations, motoric and mental symptoms. The report presents a clinical case of gelastic seizures in an adult male with hypothalamic hamartoma; the report includes the stepwise diagnosis and the treatment with transcranial magnetic stimulation (TMS). After a course of restorative therapy, control of epileptic seizures has been improved.
About the Authors
V. A. Mikhailov
St. Petersburg V. M. Bekhterev Psychoneurological Research Institute
Russian Federation
Russian Federation
MD, Deputy Director in charge of innovative research & development, Chief researcher and scientific Head at the Department for rehabilitation of patients with psychosomatic disorders, the St. Petersburg V. M. Bekhterev Psychoneurological Research Institute. Address: ul. Bekhtereva, 3, Saint Petersburg, Russia, 192019
A. K. Druzhinin
St. Petersburg V. M. Bekhterev Psychoneurological Research Institute
Russian Federation
Russian Federation
Researcher at the Department for rehabilitation of patients with psychosomatic disorders, the St. Petersburg V. M. Bekhterev Psychoneurological Research Institute. Address: ul. Bekhtereva, 3, Saint Petersburg, Russia, 192019
N. A. Shova
St. Petersburg V. M. Bekhterev Psychoneurological Research Institute
Russian Federation
Russian Federation
Medical resident at the Department for rehabilitation of patients with psychosomatic disorders, the St. Petersburg V. M. Bekhterev Psychoneurological Research Institute. Address: ul. Bekhtereva, 3, Saint Petersburg, Russia, 192019
E. A. Korsakova
St. Petersburg V. M. Bekhterev Psychoneurological Research Institute
Russian Federation
Russian Federation
PhD, Senior researcher, the Department of functional tests, the St. Petersburg V. M. Bekhterev Psychoneurological Research Institute. Address: ul. Bekhtereva, 3, Saint Petersburg, Russia, 192019
References
1. Trousseau A. Clinique Medicale de Dieu de Paris. 4th ed. Paris 1873.
2. List C. F., Dowman C. E., Bagchi B. K., Bebin J. Posterior hypothalamic hamartomas and gangliogliomas causing precocious puberty. Neurology. 1958; 8 (3): 164-74.
3. Gascon G. G., Lombroso C. T. Epileptic (gelastic) laughter. Epilepsia. 1971; 12 (1): 63-76.
4. Brandberg G., Eeg-Olofsson O. Gelastic seizures. ILAE website. Date of submission: 2001 April 19.
5. Karlov V. A., Andreeva O. V. Zhurnal nevrologii i psikhiatrii im. S. S. Korsakova (in Russian). 2006; 106 (6): 62-69.
6. Usacheva E. L., Mukhin K. Yu., Prityko A. G. et al. Zhurnal nevrologii i psikhiatrii im. S. S. Korsakova (in Russian). 2003; 103 (1): 10-16.
7. Mironov M. B., Ivanova I. V., Mukhin K. Yu. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions (in Russian). 2014; 6 (3): 20-29.
8. Kuzniecky R., Guthrie B., Mountz J., Bebin M., Faught E., Gilliam F., Liu H. G. Intrinsic epileptogenesis of hypothalamic hamartomas in gelastic epilepsy. Annals of Neurology. 1997; 42: 60-67.
9. Beggs J., Nakada S., Fenoglio K., Wu J., Coons S., Kerrigan J. F. Hypothalamic hamartomas associated with epilepsy: ultrastructural features. Journal of Neuropathology & Experimental Neurology. 2008; 67: 657-668.
10. Bogdanova L. B., Rostovtsev M. V., Bogdanov N. A., Bogdanova E. A. Radiologiya – praktika (in Russian). 2008; 1: 48-49.
11. Susheela S. P., Revannasiddaiah S., Mallarajapatna G. J., Basavalingaiah A. Robotic-arm stereotactic radiosurgery as a definitive treatment for gelastic epilepsy associated with hypothalamic hamartoma. BMJ Case Reports. 2013; 9.
12. WHO Classification of Tumours of the Central Nervous System. Eds.: Louis D. N., Ohgaki H., Wiestler O. D., Cavenee W. K. Lyon. 2007.
13. Foit N. A., van Velthoven, Schulz R., Blümcke I., Urbach H., Woermann F. G., Bien C. G. Lesional cerebellar epilepsy: a review of the evidence. Journal of Neurology. January 2017; 64 (1): 1-10.
14. Wild B., Rodden F. A., Grodd W., Ruch W. Neural correlates of laughter and humour. Brain. 2003; 126: 2121-2138.
15. Arita K., Ikawa F., Kurisu K., Sumida M., Harada K., Uozumi T., Monden S., Yoshida J., Nishi Y. The relationship between magnetic resonance imaging findings and clinical manifestations of hypothalamic hamartoma. Journal of Neurosurgery. August 1999; 91 (2): 212-220.
16. Freeman J. L., Harvey A. S., Rosenfeld J. V., Wrennall J. A., Bailey C. A., Berkovic S. F. Generalized epilepsy in hypothalamic hamartoma: evolution and postoperative resolution. Neurology. 2003; 60: 762-767.
17. Castro L. H., Ferreira L. K., Teles L. R., Jorge C. L., Arantes P. R., Ono C. R., Adda C. C., Valerio R. F. Epilepsy syndromes associated with hypothalamic hamartoma. Seizure. 2007; 16: 50-58.
18. Parvizi J., Le S., Foster B., Bourgeois B., Riviello J. J., Prenger E., Saper C., Kerrigan J. F. Gelastic epilepsy and hypothalamic hamartomas: neuroanatomical analysis of brain lesions in 100 patients. Brain. 2011; 134: 2960-2968.
19. Bajorek J. G., Lee R. J., Lomax P. Neuropeptides: a role as endogenous mediators or modulators of epileptic phenomena. Annals of Neurology. 1984; 16: 31-38.
20. Munari C., Kahane P., Francione S., Hoffman D., Tassi L., Cusmai R., Vigevano F., Pasquier B., Betti O. O. Role of the hypothalamic hamartoma in the genesis of gelastic fits (a video-stereo-EEG study). Electroencephalography and Clinical Neurophysiology. 1995; 95: 154-160.
21. Palmini A., Chandler C., Andermann F., Costa Da Costa J., Paglioli-Neto E., Polkey C., Rosenblatt B., Montes J., Martinez J. V., Farmer J. P., Sinclair B., Aronyk K., Paglioli E., Coutinho L., Raupp S., Portuguez M. Resection of the lesion in patients with hypothalamic hamartoma and catastrophic epilepsy. Neurology. 2002; 58: 1338-1347.
22. Mittal S., Mittal M., Montes J. L. Hypothalamic hamartomas. Part 1. Clinical, neuroimaging, and neurophysiological characteristics. Neurosurgical Focus – Journal of Neurosurgery. 2013; 34 (6): E6.
23. Chen R., Spencer D. C., Weston J., Nolan S. J. Transcranial magnetic stimulation for the treatment of epilepsy. Cochrane Library. 11.08.2016.
24. Druzhinin A. K., Gorelik A. L., Naryshkin A. G., Mikhailov V. A., Shova N. I. Vestnik klinicheskoi neirofiziologii (in Russian). 2016; S: 110-111.
For citation:
Mikhailov V.A., Druzhinin A.K., Shova N.A., Korsakova E.A. EPILEPSY WITH GELASTIC SEIZURES AND HYPOTHALAMIC HAMARTOMA: A RARE CLINICAL CASE. Epilepsy and paroxysmal conditions. 2017;9(3):64-72. (In Russ.) https://doi.org/10.17749/2077-8333.2017.9.3.064-072
Views: 872
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
