ABSTRACT
Gelastic (or laughing) seizures were rst described by Daly and Mulder in 1957.They are characterized by bouts of laughter that may be either similar or, more commonly, distinct from the patients’ usual laughter, and associated with a slight sensation or appearance of discomfort. A related seizure type may involve crying and/or facial contraction with an exaggerated grimace; these are referred to as dacrystic seizures. Affected patients may exhibit both forms of seizures, or seizures with mixed features of both types. Autonomic symptoms such as ushing, tachycardia, and altered respiration are often associated with these seizures. Most (but not all) of these seizures are simple partial in nature with preservation of awareness. They are usually brief (less than 30 seconds) without a postictal phase. Status gelasticus is the most severe form, dened as a prolonged cluster of gelastic seizures lasting longer than 20-30 minutes. Patients usually do not report a feeling of mirth. In its mildest form, patients have simply described an urge to laugh that can be self suppressed. Scalp EEG monitoring usually does not show any ictal correlate. Typically, the seizure diagnosis is missed or delayed for many years and is often misdiagnosed as a “happy baby,” colic, or gastroesophageal reux disease. Patients with gelastic seizures should undergo detailed neuroimaging with particular emphasis on the hypothalamus, including MRI brain scans with ne coronal sections through this region.
