Ecstatic and gelastic seizures relate to the hypothalamus

Abstract

Ecstatic seizures constitute a rare form of epilepsy, and the semiology is diverse. Previously, brain areas including the temporal lobe and the insula have been identified to be involved in clinical expression. The aim of this report is to review changes in ecstatic seizures in a patient before and after operation of a hypothalamic hamartoma, and to scrutinize the relation to gelastic seizures. In this case, the ecstatic seizures disappeared after surgery of the hamartoma but reappeared eleven years later. Clinical information was retrospectively obtained from medical records, interviews, and a questionnaire covering seizure semiology that pertained to ecstatic and gelastic seizures. Our findings imply a possible connection between gelastic and ecstatic seizures, originating from a hypothalamic hamartoma. To our knowledge, this location has not previously been described in ecstatic seizures. Gelastic seizures may in this case were associated with ecstatic seizures. We speclate patients with ecstatic seizures may have an ictal activation of neuronal networks that involves the insula. Our case may add information to the growing knowledge concerning ecstatic seizures.

Keywords: Ecstatic seizures; Epilepsy; Gelastic seizures; Hamartoma; Hypothalamus.

Fig. 1

Three anatomic T1-weighted MRI axial images during presurgical evaluation in 2005 (A) postsurgical evaluation in 2006 (B) and 2017 (C). Note that following initial surgical resection in 2006, the tumor volume was reduced to less than half of the original one. The arrow points to the intraventricular component of the tumor, in relation to the lateral inferior wall of the third ventricle.