When Baby’s giggles are not funny: seven years overlooked diagnosis in a case of gelastic seizures

Main Article Content

Montri Saengpattrachai, MD


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. 


Download data is not yet available.

Article Details

How to Cite
Saengpattrachai M. When Baby’s giggles are not funny: seven years overlooked diagnosis in a case of gelastic seizures. BKK Med J [Internet]. 2011Sep.20 [cited 2020Jul.16];2(1):53. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/217730
Case Report


1. Gascon GG, Lombroso CT. Epileptic (gelastic) laughter. Epilepsia 1971;12:63-76.
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.