When Baby’s giggles are not funny: seven years overlooked diagnosis in a case of gelastic seizures
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Published:
Sep 20, 2011
Keywords:
Giggles Pathologic laughter Ictal laughing Gelastic seizures Hypothalamic hamartoma Tuber cinereum
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Abstract
Laughter actually has positive emotional effect. However, it could be pathologic when laughter is not related to emotion and occurs independent of a stimulus in the environment. We reported a 7-year-6-month old Thai boy who presented with ‘early giggles’ since the age of 2 months. Despite parental concerns, the symptoms were overlooked until seven years of age, when he developed complex partial seizures. An MRI study of the brain revealed a small ill defined lesion within the tuber cinereum that was compatible with hypothalamic hamartoma.
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1.
Saengpattrachai M. When Baby’s giggles are not funny: seven years overlooked diagnosis in a case of gelastic seizures. BKK Med J [internet]. 2011 Sep. 20 [cited 2026 Oct. 21];2(1):53. available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/217730
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Case Report
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References
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2. Arroyo S, Lesser RP, Gordon B, et al. Mirth, laughter and gelastic seizures. Brain 1993;116:757-80.
3. Harvey AS, Freeman JL. Epilepsy in hypothalamic hamartoma: clinical and EEG features. Semin Pediatr Neurol 2007;14:60-4.
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5. Udaka F, Yamao S, Negata H, et al. Pathologic laughing and crying treated with levodopa. Arch Neurol 1984; 41:1095-6.
6. Nirenberg SA. Normal and pathologic laughter in children. Clin Pediatr (Phila) 1991;30:630-2.
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8. Cheung CS, Parrent AG, Burneo JG. Gelastic seizures: not always hypothalamic hamartoma. Epileptic Disord 2007;9:453-8.
9. Penfold JL, Manson JI, Caldicott WM. Laughing seizures and precocious puberty (case report and review of the literature). Aust Paediatr J 1978;14:185-90.
10. Frattali CM, Liow K, Craig GH, et al. Cognitive deficits in children with gelastic seizures and hypothalamic hamartoma. Neurology 2001;57:43-6.
11. Deonna T, Ziegler AL. Hypothalamic hamartoma, precocious puberty and gelastic seizures: a special model of “epileptic” developmental disorder. Epileptic Disord 2000;2:33-7.
12. Prigatano GP, Wethe JV, Gray JA, et al. Intellectual functioning in presurgical patients with hypothalamic hamartoma and refractory Epilepsy. Epilepsy Behav 2008; 3:149-55.
13. Nguyen D, Singh S, Zaatreh M, et al. Hypothalamic hamartomas: seven cases and review of the literature. Epilepsy Behav 2003;4:246-58.
14. Berkovic S, Anderman F, Melanson D, et al. Hypothalamic hemartoma and ictal laughter: evolution of a characteristic epileptic syndrome and diagnostic value of magnetic resonance imaging. Ann Neurol 1988;23:429-39.
15. Quiske A, Frings L, Wagner K, et al. Cognitive functions in juvenile and adult patients with gelastic epilepsy due to hypothalamic hamartoma. Epilepsia 2006;47:153-8.
16. Striano S, Striano P, Cirillo S, et al. Small hypothalamic hamartomas and gelastic seizures. Epileptic Disord 2002;4:129-33.
17. Valdueza JM, Cristante L, Dammann O, et al. Hypothalamic hamartomas: with special reference to gelastic epilepsy and surgery. Neurosurgery 1994;34:949-58.
18. Téllez-Zenteno JF, Serrano-Almeida C, Moien-Afshari F. Gelastic seizures associated with hypothalamic hamartomas. An update in the clinical presentation, diagnosis and treatment. Neuropsychiatr Dis Treat 2008;4:1021-31.
19. Albright AL, Lee PA. Neurosurgical treatment of hypothalamic hamartomas causing precocious puberty. J Neurosurg 1993;78:77-82.
20. Starceski PJ, Lee PA, Albright AL, et al. Hypothalamic hamartomas and sexual precocity. Evaluation of treatment options. Am J Dis Child 1990;144:225-8.
21. Palmini A, Chandler C, Andermann F, et al. Resection of the lesion in patients with hypothalamic hamartomas and catastrophic epilepsy. Neurology 2002;58:1338-47.
22. Mullatti N, Selway R, Nashef L, et al. The clinical spectrum of epilepsy in children and adults with hypothalamic hamartoma. Epilepsia 2003;44:1313-19.
23. Striano S, Meo R, Bilo L, et al. Gelastic epilepsy: symptomatic and cryptogenic cases. Epilepsia 1999;40:294-302.
24. Brandberg G, Raininko R, Eeg-Olofsson O. Hypothalamic hamartoma with gelastic seizures in Swedish children and adolescents. Eur J Paediatr Neurol 2004; 8:35-44.
25. Cascino GD, Andermann F, Berkovic SF, et al. Gelastic seizures and hypothalamic hamartomas: evaluation of patients undergoing chronic intracranial EEG monitoring and outcome of surgical treatment. Neurology 1993; 43:747-50.
26. Romanelli P, Muacevic A, Striano S. Radiosurgery for hypothalamic hamartoma. Neurosurg Focus 2008;24:E9
27. Sturm JW, Andermann F, Berkovic SF. “Pressure to laugh”: an unusual epileptic symptom associated with small hypothalamic hamartomas. Neurology 2000;54: 971-3.
28. Bunyaratavej K, Locharernkul C, Tepmongkol S, et al. Successful resection of Hypothalamic harmatoma with intractable gelastic seizures- by transcallosal subchoroidal approach. J Med Assoc Thai 2006;89:1269-76.
2. Arroyo S, Lesser RP, Gordon B, et al. Mirth, laughter and gelastic seizures. Brain 1993;116:757-80.
3. Harvey AS, Freeman JL. Epilepsy in hypothalamic hamartoma: clinical and EEG features. Semin Pediatr Neurol 2007;14:60-4.
4. Striano S, Striano P, Sarappa C, et al. The clinical spectrum and natural history of gelastic epilepsy-hypothalamic hamartoma syndrome. Seizure 2005;14:232-9.
5. Udaka F, Yamao S, Negata H, et al. Pathologic laughing and crying treated with levodopa. Arch Neurol 1984; 41:1095-6.
6. Nirenberg SA. Normal and pathologic laughter in children. Clin Pediatr (Phila) 1991;30:630-2.
7. Kerrigan JF, Nq YT, Chung S, et al. The hypothalamic hamartoma: a model of subcortical epileptogenesis and encephalopathy. Semin Pediatr Neurol 2005;12:119-31.
8. Cheung CS, Parrent AG, Burneo JG. Gelastic seizures: not always hypothalamic hamartoma. Epileptic Disord 2007;9:453-8.
9. Penfold JL, Manson JI, Caldicott WM. Laughing seizures and precocious puberty (case report and review of the literature). Aust Paediatr J 1978;14:185-90.
10. Frattali CM, Liow K, Craig GH, et al. Cognitive deficits in children with gelastic seizures and hypothalamic hamartoma. Neurology 2001;57:43-6.
11. Deonna T, Ziegler AL. Hypothalamic hamartoma, precocious puberty and gelastic seizures: a special model of “epileptic” developmental disorder. Epileptic Disord 2000;2:33-7.
12. Prigatano GP, Wethe JV, Gray JA, et al. Intellectual functioning in presurgical patients with hypothalamic hamartoma and refractory Epilepsy. Epilepsy Behav 2008; 3:149-55.
13. Nguyen D, Singh S, Zaatreh M, et al. Hypothalamic hamartomas: seven cases and review of the literature. Epilepsy Behav 2003;4:246-58.
14. Berkovic S, Anderman F, Melanson D, et al. Hypothalamic hemartoma and ictal laughter: evolution of a characteristic epileptic syndrome and diagnostic value of magnetic resonance imaging. Ann Neurol 1988;23:429-39.
15. Quiske A, Frings L, Wagner K, et al. Cognitive functions in juvenile and adult patients with gelastic epilepsy due to hypothalamic hamartoma. Epilepsia 2006;47:153-8.
16. Striano S, Striano P, Cirillo S, et al. Small hypothalamic hamartomas and gelastic seizures. Epileptic Disord 2002;4:129-33.
17. Valdueza JM, Cristante L, Dammann O, et al. Hypothalamic hamartomas: with special reference to gelastic epilepsy and surgery. Neurosurgery 1994;34:949-58.
18. Téllez-Zenteno JF, Serrano-Almeida C, Moien-Afshari F. Gelastic seizures associated with hypothalamic hamartomas. An update in the clinical presentation, diagnosis and treatment. Neuropsychiatr Dis Treat 2008;4:1021-31.
19. Albright AL, Lee PA. Neurosurgical treatment of hypothalamic hamartomas causing precocious puberty. J Neurosurg 1993;78:77-82.
20. Starceski PJ, Lee PA, Albright AL, et al. Hypothalamic hamartomas and sexual precocity. Evaluation of treatment options. Am J Dis Child 1990;144:225-8.
21. Palmini A, Chandler C, Andermann F, et al. Resection of the lesion in patients with hypothalamic hamartomas and catastrophic epilepsy. Neurology 2002;58:1338-47.
22. Mullatti N, Selway R, Nashef L, et al. The clinical spectrum of epilepsy in children and adults with hypothalamic hamartoma. Epilepsia 2003;44:1313-19.
23. Striano S, Meo R, Bilo L, et al. Gelastic epilepsy: symptomatic and cryptogenic cases. Epilepsia 1999;40:294-302.
24. Brandberg G, Raininko R, Eeg-Olofsson O. Hypothalamic hamartoma with gelastic seizures in Swedish children and adolescents. Eur J Paediatr Neurol 2004; 8:35-44.
25. Cascino GD, Andermann F, Berkovic SF, et al. Gelastic seizures and hypothalamic hamartomas: evaluation of patients undergoing chronic intracranial EEG monitoring and outcome of surgical treatment. Neurology 1993; 43:747-50.
26. Romanelli P, Muacevic A, Striano S. Radiosurgery for hypothalamic hamartoma. Neurosurg Focus 2008;24:E9
27. Sturm JW, Andermann F, Berkovic SF. “Pressure to laugh”: an unusual epileptic symptom associated with small hypothalamic hamartomas. Neurology 2000;54: 971-3.
28. Bunyaratavej K, Locharernkul C, Tepmongkol S, et al. Successful resection of Hypothalamic harmatoma with intractable gelastic seizures- by transcallosal subchoroidal approach. J Med Assoc Thai 2006;89:1269-76.
