Gelastic, quiritarian, and cursive epilepsy. A clinicopathological appraisal.

Abstract

SYNOPSIS A patient is reported with episodes of epileptic laughter, crying, and running occurring alone or in combination. He was found to have a discrete, well-circumscribed tumour of the left temporal lobe. The neurology of these epileptic events is discussed in relation to the pathological lesion.Laughter as an epileptic phenomenon is extremely uncommon and equally so is episodic running. The combination of these two forms of epilepsy-'gelastic' (laughter) and 'cursive' (running)-in the same individual is rare. There are only two earlier reports, of in all, three cases (Sisler et al., 1953;Chen and Forster, 1973). All these cases resulted from diffuse cerebral disorder. We studied an individual with such episodic events of laughter, running and also crying occurring alone or in combination, associated with a discrete neoplastic lesion in the left temporal lobe. This case permits appraisal of cerebral localization of 'centres' for the physical expression of emotions. Crying as an ictal event has not received much attention in the literature. We coin the word 'quiritarian' epilepsy (quiritare: Latin: to cry/scream) to indicate this phenomenon. CASE REPORTA 33 year old infantry soldier was evacuated to our neurological centre with a history of episodic seizures for one and a half years. He was observed to have four to six seizures a day, lasting 0.5-1.0 minute. In some of these episodes he would burst into crying, while in others into laughter and sometimes there was a curious mixture of both. The laughter did not have an infectious quality. He was later observed to have, in addition, episodes of running. There was no con- (Figs. 1-4). He suddenly burst into laughter, with squeezing of the eyelids (Fig. 1) and, at the same time rubbing his upper abdomen, ran to the other end of the room near the door (Fig. 2), then turned and ran diagonally across with an expression of fear on his face (Fig. 3), followed immediately by a frozen expression of defiance, keeping both hands in the position of boxing, standing against the wall as if ready to fight (Fig. 4). The whole episode lasted for about 90 seconds. Postictally for about 30 seconds he would brush aside any attempts to take his pulse, very arrogantly. After that, he was his normal self with no memory for the whole episode.There was no history of trauma or any febrile episode in the past and no history of epilepsy in the family. Systemic survey and neurological examination were within normal limits except for a right central type of facial asymmetry. Electroencephalography showed generalized spike discharges during seizures induced by hyperventilation with an epileptogenic focus in the left temporal lobe. Routine laboratory investigations and radiography of the skull did not reveal any abnormalities. Left carotid angiography showed changes consistent with a relatively avascular space occupying lesion in the anterior and middle temporal area (Fig. 5a, b).OPERATIVE FINDINGS At left temporal craniotomy he was found to have a light yellowish-brown, wellcircumscribed, ...

Emotionalism Following Brain Damage

“…Crying or laughing occasionally occurs as part of the ictus in epilepsy (dacrystic and gelastic epilepsy respectively) (Offen et at., 1976;Sethi and Rao, 1976) and even less commonly as a dramatic presenting feature in patients with brain stem pathology (Fere, 1903). Following stroke, patients with emotionalism have more symptoms of mood disorder and more diagnosable psychiatric disorder (only at 6 months) (House et at., 1989).…”

Laughing Seizures: A Case Report

“…They are usually associated with other seizure types and some patients may also have crying or "Dacrystic" seizures. [6] We are reporting a case of hypothalamic hamartoma, initially presenting with laughing seizures. …”

Epilepsia cursiva

“…A detailed survey of the cases published in the last 50 years [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17]shows that the affected patients are predominantly young males with a mean age of 19 years and a male to female ratio of 2:1.…”

“…Findings include dysrhythmic activity and spikes-and-waves discharges. Only a limited number of ictal recordings [5, 6, 7, 8, 9]of running seizures are available. They show spikes or spikes-and-waves trains most frequently over the temporal lobes.…”

“…The main hypothesis proposed by most authors is based on the idea that running during a seizure is ‘... a dynamic physical expression of an internal state of fear’ [8]. Fear or anxiety in this context is considered as the result of epileptic discharges in the limbic system.…”