Case report. Gelastic seizures in a patient with right gyrus cinguli astrocytoma

Abstract

Objective and importance: Gelastic seizure (GS) also known as "gelastic epilepsy" is a rare type of seizure associated with several different conditions such as tumors--hypothalamic hamartromas, tuberous sclerosis, hemangiomas, post infectious foci, cortical temporal dysplasia. We report one case of this rare condition generated by a right gyrus cinguli gr. II astrocytoma.

Clinical presentation: A 27 year-old male, right handed, was admitted for a 2 years history of very frequent gelastic seizures accompanied sometimes by simple motor partial seizures in both arms, more often being involved his left arm, without impairment of his consciousness state. His neurological examination was normal. Diagnosis was made on native CT scan: minimal hypodense frontal right paramedian lesion, cerebral MRI showed a small well delimited right, parenchymal, homogeneous lesion (16/22/15 mm), involving gyrus cinguli, without perilesional edema and mass effect, hyperintense both on T1 and T2 MR sequences, non-enhancing after Gadolinium. The cerebral lesion was also documented on EEG and video-EEG recordings. Using an interhemispheric microsurgical approach, above the corpus callosum and the right pericallosal artery, at the level of gyrus cinguli, a yellow-gray, infiltrative tumor, having a moderate vascularisation, has been identified and totally removed. The anatomopathological analysis revealed a grade II astrocytoma. The patient recovered very well, without deficits, no gelastic seizures or epileptic manifestations; three months after operation he is still free of seizures.

Conclusion: A case of gelastic seizures accompanied by simple motor partial seizures in both arms, without the impairment of his consciousness state induced by a grade II right gyrus cinguli astrocytoma is described and documented by radiological and electrophysiological studies. Using microsurgical resection, the tumor was totally removed, the patient clinical condition improved. Without an affective connotation as in temporal or hypothalamus topography, gelastic seizures are not patognomonic for hypothalamic hamartomas and in the case of frontal localization of the lesion; they can be associated with motor involvement of the limbs as in our case.

Figure 1

A. Preoperatory native CT scan: minimal hypodense frontal right paramedian lesion, B. T₁ cerebral MRI small hyperintense parenchymal homogeneous lesion 16/22/15mm, well delimited, involving gyrus cinguli, without perilesional edema and mass effect, C hyperintense lesion on T₂ MR sequences, non–enhancing after Gadolinium, D coronal lesion T₁ MR sequences, E sagital lesion T₂ MR sequences, G and H Postoperatory CT scan, I EEG recording: medio–frontal origin and rare interictal epileptiforme elements