Cryptogenic gelastic epilepsy originating from the right temporal lobe

Abstract

Objective: To present a case of intractable cryptogenic gelastic epilepsy with ictal video-EEG to localize the seizure focus.

Clinical presentation and intervention: A 39-year-old female presented with a 2-year history of intractable gelastic epilepsy characterized by recurrent episodes of stereotyped pathological laughter, transient unresponsiveness, automatisms and brief postictal confusion. The patient failed to respond to multiple antiepileptic drugs. Several interictal EEGs did not show any abnormalities. Magnetic resonance imaging of the head with seizure protocol and diffusion tensor imaging were normal. Ictal video-EEG monitoring showed rhythmic, sharp activity emanating from the right temporal lobe.

Conclusion: This case suggests that the right temporal lobe may be actively involved in the epileptogenic network generating gelastic epilepsy. Video-EEG monitoring should be considered for patients with gelastic epilepsies to better clarify the nature of events, localize the seizure focus and correlate EEG changes with the clinical manifestations.