What Causes Uncontrolled Laughter In Epilepsy?

In many people with epilepsy, it has been observed that when they have an episode of seizure that break out into uncontrolled laughter for no valid reason. It is completely involuntary and they do not seem to have a control over it. This is medically termed as Gelastic Seizure. It is a very rare form of epilepsy. These seizures are mostly associated with behavioral problems and abnormal cognitive development. It has been observed that majority of the cases of gelastic Seizures develop from hypothalamic hamartomas which are benign masses that consist of gray matter.[1,2,3]

In some cases people with frontal and temporal lobe lesions have also been noted to have gelastic seizures. With regard to the epidemiology, there is very limited data in the literature, especially with regard to the adult population. However, according to one study done in London, it has been estimated that less 0.8% of all epilepsy patients had gelastic seizures.[1,2,3]

Sometimes, uncontrolled laughter may also be seen in other variants of seizures and thus may go unnoticed.[1,2,3] The article below highlights some of the causes of uncontrolled laughter in epilepsy.

What Causes Uncontrolled Laughter In Epilepsy?

As stated, uncontrolled laughter in epilepsy is medically termed as gelastic seizures and is an extremely rare form of epilepsy. It is mostly seen in patients with a known diagnosis of benign brain masses that develop in the hypothalamus called hypothalamic hamartomas. To explore the causes of uncontrolled laugher in epilepsy, researchers from University of Hawaii came across a patient with a history of gelastic seizures characterized by uncontrolled laughter since childhood.[3]

Till the time, the man had met the researchers, the condition had remained undiagnosed and needless to say he had received no treatment for it. He had been experiencing uncontrollable laughter at least two to three times a week since he was 8 years old. When looking at the past medical history of this man, it was noted that he was diagnosed with brain tumor, diabetes and had schizophrenia. There was also a history of cognitive impairment and behavioral changes.[3]

The researchers did an EEG which detected abnormal activity in the right frontotemporal region of the brain confirming epilepsy. Further testing with MRI revealed that there was a distinct malformation on the hypothalamus which was consistent with a hypothalamic hamartoma. All these features clearly confirmed a diagnosis of gelastic seizures.[3]

The episode of uncontrollable laughter was then brought under control by way of medications which decreased the seizure frequency. The researchers believe that it is important to look for epilepsy in people who present with unusual episode such as inappropriate laughter as better care can be given once a cause for the unusual and abnormal behavior is identified.[3]

The road ahead for the researchers is to stress the importance of not overlooking a possible diagnosis of gelastic seizures, especially in people with abnormal behavior such as an uncontrolled laughter for no valid reason and confirm the diagnosis with EEG and MRI of the brain.[3]

They mention that the workup should include imaging with attention to the suprasellar region along with EEG. An accurate diagnosis and proper treatment is the key to prevent such abnormal behavior as seen in people with gelastic seizures.[3]

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