Pub Date : 2024-03-27DOI: 10.1684/j.1950-6945.2002.tb00481.x
D.G.A. Kasteleijn‐Nolst Trenité, A. Martins da Silva, S. Ricci, G. Rubboli, C.A. Tassinari, J. Lopes, M. Bettencourt, J. Oosting, J.P. Segers
Background Video game seizures have been reported in photosensitive and non‐photosensitive patients with epilepsy. The game Super Mario World, has led to many cases of first seizures. We examined whether this game was indeed more provocative than other programs and whether playing the game added to this effect. Methods We prospectively investigated 352 patients in four European cities, using a standard protocol including testing of a variety of visual stimuli. We correlated historical data on provocative factors in daily life with electroencephalographic laboratory findings. Results The video game, Super Mario World proved more epileptogenic than standard TV programs and as provocative as programs with flashing lights and patterns. Most striking was the fact that video game‐viewing and‐playing on the 50 and 100 Hz TV was significantly more provocative than viewing the standard program ( P < 0.001, P < 0.05 respectively). Playing the video game Mario World on a 50 Hz TV, appeared to be significantly more provocative than playing this game on the 100 Hz TV ( P < 0.001). Of 163 patients with a history of TV‐, VG‐ or CG‐seizures, 85% of them showed epileptiform discharges in response to photic stimulation, 44% to patterns, 59% to 50 Hz TV and 29% to 100 Hz TV. Conclusions Children and adolescents with a history of video game seizures are, in the vast majority, photosensitive and should be investigated with standardised photic stimulation. Games and programs with bright background or flashing images are specifically provocative. Playing a video game on a 100 Hz TV is less provocative [published with videosequences].
{"title":"Video games are exciting: a European study of video game‐induced seizures and epilepsy","authors":"D.G.A. Kasteleijn‐Nolst Trenité, A. Martins da Silva, S. Ricci, G. Rubboli, C.A. Tassinari, J. Lopes, M. Bettencourt, J. Oosting, J.P. Segers","doi":"10.1684/j.1950-6945.2002.tb00481.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.2002.tb00481.x","url":null,"abstract":"Background Video game seizures have been reported in photosensitive and non‐photosensitive patients with epilepsy. The game Super Mario World, has led to many cases of first seizures. We examined whether this game was indeed more provocative than other programs and whether playing the game added to this effect. Methods We prospectively investigated 352 patients in four European cities, using a standard protocol including testing of a variety of visual stimuli. We correlated historical data on provocative factors in daily life with electroencephalographic laboratory findings. Results The video game, Super Mario World proved more epileptogenic than standard TV programs and as provocative as programs with flashing lights and patterns. Most striking was the fact that video game‐viewing and‐playing on the 50 and 100 Hz TV was significantly more provocative than viewing the standard program ( <jats:italic>P</jats:italic> < 0.001, <jats:italic>P</jats:italic> < 0.05 respectively). Playing the video game Mario World on a 50 Hz TV, appeared to be significantly more provocative than playing this game on the 100 Hz TV ( <jats:italic>P</jats:italic> < 0.001). Of 163 patients with a history of TV‐, VG‐ or CG‐seizures, 85% of them showed epileptiform discharges in response to photic stimulation, 44% to patterns, 59% to 50 Hz TV and 29% to 100 Hz TV. Conclusions Children and adolescents with a history of video game seizures are, in the vast majority, photosensitive and should be investigated with standardised photic stimulation. Games and programs with bright background or flashing images are specifically provocative. Playing a video game on a 100 Hz TV is less provocative [published with videosequences].","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140312960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1684/j.1950-6945.2002.tb00518.x
Franck Semah
Positron emission tomography (PET) may be used to map regional cerebral glucose metabolism using 18 F‐deoxyglucose‐PET in patients with partial epilepsy. An area of reduced glucose metabolism, that is commonly more extensive than the underlying anatomical abnormality, is reported in most of the patients with medically refractory partial epilepsy. These functional changes are useful in the delineation of the epileptogenic focus prior to surgery. Nevertheless, in patients with mesial temporal lobe epilepsy (MTLE) without mass lesion, the hypometabolism involves a large area of the temporal lobe, including the mesial structures, the temporal pole and part of the lateral temporal cortex. In such patients with MTLE, subcortical structures and extratemporal lobe areas are also often hypometabolic. The reasons for this large hypometabolism remain debated. In MTLE patients, the most severe hypometabolism is found in the temporo‐polar region. The clinical significance of this temporo‐polar hypometabolism is unknown. The pathophysiology of interictal hypometabolism probably involves several mechanisms, such as neuronal loss, deafferentation, postictal depression, and others epilepsy‐related phenomena. The relationship between interictal temporo‐polar hypometabolism and seizure onset or seizure spread remain speculative.
{"title":"Temporoporal metabolic abnormalities in temporal lobe epilepsies","authors":"Franck Semah","doi":"10.1684/j.1950-6945.2002.tb00518.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.2002.tb00518.x","url":null,"abstract":"Positron emission tomography (PET) may be used to map regional cerebral glucose metabolism using <jats:sup>18</jats:sup> F‐deoxyglucose‐PET in patients with partial epilepsy. An area of reduced glucose metabolism, that is commonly more extensive than the underlying anatomical abnormality, is reported in most of the patients with medically refractory partial epilepsy. These functional changes are useful in the delineation of the epileptogenic focus prior to surgery. Nevertheless, in patients with mesial temporal lobe epilepsy (MTLE) without mass lesion, the hypometabolism involves a large area of the temporal lobe, including the mesial structures, the temporal pole and part of the lateral temporal cortex. In such patients with MTLE, subcortical structures and extratemporal lobe areas are also often hypometabolic. The reasons for this large hypometabolism remain debated. In MTLE patients, the most severe hypometabolism is found in the temporo‐polar region. The clinical significance of this temporo‐polar hypometabolism is unknown. The pathophysiology of interictal hypometabolism probably involves several mechanisms, such as neuronal loss, deafferentation, postictal depression, and others epilepsy‐related phenomena. The relationship between interictal temporo‐polar hypometabolism and seizure onset or seizure spread remain speculative.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140313011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1684/j.1950-6945.2003.tb00564.x
Soheyl Noachtar
Subdural electrodes are useful in selected patients with cortical dysplasia for planning resective epilepsy surgery. Their potential risks have to be balanced against the diagnostic yield and expected benefit of epilepsy surgery for the patient. Recent advances in imaging techniques now allow more accurate placement of the subdural electrodes and also limit the number required.
{"title":"Subdural electrodes in focal cortical dysplasia","authors":"Soheyl Noachtar","doi":"10.1684/j.1950-6945.2003.tb00564.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.2003.tb00564.x","url":null,"abstract":"Subdural electrodes are useful in selected patients with cortical dysplasia for planning resective epilepsy surgery. Their potential risks have to be balanced against the diagnostic yield and expected benefit of epilepsy surgery for the patient. Recent advances in imaging techniques now allow more accurate placement of the subdural electrodes and also limit the number required.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140312884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this paper, three more cases of eating‐induced seizures are reported. We have obtained ictal video‐electroencephalogram (EEG) recordings for two patients, which confirm the heterogeneity of ictal semiology of these seizures. However, in all the cases the inclusion of this kind of reflex epilepsy (RE) among the localization‐related epilepsies (LRE) is confirmed. The usefulness of video EEG monitoring in studying these seizures and reflex epilepsy in general (RE) is stressed.
{"title":"Eating epilepsy. Heterogeneity of ictal semiology: the role of video‐EEG monitoring","authors":"Vincenzo Loreto, Cristofaro Nocerino, Pasquale Striano, Federica D'Aulos, Patrizia Boccella, Salvatore Striano","doi":"10.1684/j.1950-6945.2000.tb00362.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.2000.tb00362.x","url":null,"abstract":"In this paper, three more cases of eating‐induced seizures are reported. We have obtained ictal video‐electroencephalogram (EEG) recordings for two patients, which confirm the heterogeneity of ictal semiology of these seizures. However, in all the cases the inclusion of this kind of reflex epilepsy (RE) among the localization‐related epilepsies (LRE) is confirmed. The usefulness of video EEG monitoring in studying these seizures and reflex epilepsy in general (RE) is stressed.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140312886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1684/j.1950-6945.1999.tb00286.x
Jean Aicardi
{"title":"Message from the Editor","authors":"Jean Aicardi","doi":"10.1684/j.1950-6945.1999.tb00286.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.1999.tb00286.x","url":null,"abstract":"","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140312980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1684/j.1950-6945.2000.tb00352.x
Daniel L. Keene, Sharon Whiting, Enrique C.G. Ventureyra
Electrocorticography (ECOG), the intra‐operative recording of cortical potentials, has played an important role in the surgical management of patients with medically refractory epilepsy. It has been used 1) to localize the epileptogenic tissue; 2) map out cortical functions; and 3) predict the success of the surgery. Despite its common use, few studies have been done to prove its effectiveness in these areas. The technique used in children for recording ECOG is very similar to that used in adults except for the limitations imposed by the child's age. Anaesthesia must often be used. Based upon a computerized medical literature search, a review of this procedure was done. Pre‐resection localization, and post‐resection prediction of outcome was done for temporal and extra‐temporal resection, both lesional and nonlesional. Most of the available studies were in adult patients. All were retrospective in nature. Evidence for the role of pre‐resection ECOG in determining the degree of resection felt necessary to obtain good clinical outcome was limited. Similarly the post‐resection ECOG predication of surgical outcome was restricted.
{"title":"Electrocorticography","authors":"Daniel L. Keene, Sharon Whiting, Enrique C.G. Ventureyra","doi":"10.1684/j.1950-6945.2000.tb00352.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.2000.tb00352.x","url":null,"abstract":"Electrocorticography (ECOG), the intra‐operative recording of cortical potentials, has played an important role in the surgical management of patients with medically refractory epilepsy. It has been used 1) to localize the epileptogenic tissue; 2) map out cortical functions; and 3) predict the success of the surgery. Despite its common use, few studies have been done to prove its effectiveness in these areas. The technique used in children for recording ECOG is very similar to that used in adults except for the limitations imposed by the child's age. Anaesthesia must often be used. Based upon a computerized medical literature search, a review of this procedure was done. Pre‐resection localization, and post‐resection prediction of outcome was done for temporal and extra‐temporal resection, both lesional and nonlesional. Most of the available studies were in adult patients. All were retrospective in nature. Evidence for the role of pre‐resection ECOG in determining the degree of resection felt necessary to obtain good clinical outcome was limited. Similarly the post‐resection ECOG predication of surgical outcome was restricted.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140313014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1684/j.1950-6945.2000.tb00375.x
Eugen Trinka, François Dubeau, Frederick Andermann, Alexandre Bastos, Andrew Hui, Li Min Li, Stefan Köhler, André Olivier
Objectives The aim of this study is to characterize the clinical features and prognostic factors for intractable, post‐encephalitic epilepsy. Methods We studied retrospectively 42 patients (26 men) evaluated between 1982 and 1999. MRI, neuropsychological findings, interictal and ictal scalp EEG were reviewed for all patients. Fifteen patients had additional stereo EEG (SEEG) studies. Results The mean age at encephalitis was 17 years (SD = 15.5); etiology was identified in 18 patients. During the acute illness, 79% had status epilepticus (SE) or recurrent seizures and 76% were in coma; mean Glasgow outcome scale (GOS) was 3.6 (SD = 0.8). The mean latency to seizure onset was 0.8 years (SD = 1.9). The majority (72%) presented with complex partial seizures with or without secondary generalization. According to interictal epileptiform findings and the predominant seizure onset pattern as found on scalp EEG, patients were unilateral temporal (UTLE) = 8, bilateral temporal (BTLE) = 12, and extratemporal/multifocal or generalized (ETMFE) = 22 patients. MRI atrophy and/or signal changes were unilateral temporal in 7 (18%), bilateral temporal in 5 (13%), multilobar/diffuse in 20 (51%), and absent in 7 (18%). ANOVA revealed significant differences in mean GOS between UTLE versus BTLE and ETMFE (4.7 versus 3.2 versus 3.6; p < 0.0001), but not in age at encephalitis. Latency to the first unprovoked seizure was shorter in patients with ETMFE compared to UTLE and BTLE (p < 0.01). Surgery was performed in 24 patients. The best outcome was obtained in UTLE (7/8 class I and II). In the others, outcome was poor in the majority (13/16 class III and IV). Conclusion There is a small subgroup of patients with postencephalitic UTLE for whom the outcome is favorable. The majority of our patients had multifocal seizure onset with BTLE and ETMFE, and poor outcome after surgical treatment.
{"title":"Clinical findings, imaging characteristics and outcome in catastrophic post‐encephalitic epilepsy","authors":"Eugen Trinka, François Dubeau, Frederick Andermann, Alexandre Bastos, Andrew Hui, Li Min Li, Stefan Köhler, André Olivier","doi":"10.1684/j.1950-6945.2000.tb00375.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.2000.tb00375.x","url":null,"abstract":"Objectives The aim of this study is to characterize the clinical features and prognostic factors for intractable, post‐encephalitic epilepsy. Methods We studied retrospectively 42 patients (26 men) evaluated between 1982 and 1999. MRI, neuropsychological findings, interictal and ictal scalp EEG were reviewed for all patients. Fifteen patients had additional stereo EEG (SEEG) studies. Results The mean age at encephalitis was 17 years (SD = 15.5); etiology was identified in 18 patients. During the acute illness, 79% had status epilepticus (SE) or recurrent seizures and 76% were in coma; mean Glasgow outcome scale (GOS) was 3.6 (SD = 0.8). The mean latency to seizure onset was 0.8 years (SD = 1.9). The majority (72%) presented with complex partial seizures with or without secondary generalization. According to interictal epileptiform findings and the predominant seizure onset pattern as found on scalp EEG, patients were unilateral temporal (UTLE) = 8, bilateral temporal (BTLE) = 12, and extratemporal/multifocal or generalized (ETMFE) = 22 patients. MRI atrophy and/or signal changes were unilateral temporal in 7 (18%), bilateral temporal in 5 (13%), multilobar/diffuse in 20 (51%), and absent in 7 (18%). ANOVA revealed significant differences in mean GOS between UTLE versus BTLE and ETMFE (4.7 <jats:italic>versus</jats:italic> 3.2 <jats:italic>versus</jats:italic> 3.6; p < 0.0001), but not in age at encephalitis. Latency to the first unprovoked seizure was shorter in patients with ETMFE compared to UTLE and BTLE (p < 0.01). Surgery was performed in 24 patients. The best outcome was obtained in UTLE (7/8 class I and II). In the others, outcome was poor in the majority (13/16 class III and IV). Conclusion There is a small subgroup of patients with postencephalitic UTLE for whom the outcome is favorable. The majority of our patients had multifocal seizure onset with BTLE and ETMFE, and poor outcome after surgical treatment.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140312957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A clinically tonic seizure phase, immediately followed by psychomotor features (right hand dystonic posture, left hand and oral automatisms), was recorded by video and EEG, in a patient who had gliosis of the left temporal lobe and left hippocampal atrophy. Interictal epileptiform discharges were frequently seen in the left temporal area, and at the time of the tonic seizure phase, ictal spike discharges were continuously observed at the left posterior temporal area, which was recognized only by applying a high frequency filter (HFF) of 15 Hz to the digitally recorded EEG because EMG artifacts totally obscured the EEG with a HFF of 60 Hz. It is most likely that tonic seizure can occur in an adult patient with temporal lobe epilepsy, and it is speculated that an epileptogenic focus might activate a certain brain area which is regarded as a symptomatogenic zone for tonic seizures. If the tonic seizure phase is immediately followed by psychomotor features as seen in the present patient, the former could be due to focal epilepsy.
{"title":"Seizure with prominent tonic initial signs followed by psychomotor features: a case report clinically manifesting an unusual ictal evolution","authors":"Akio Ikeda, Akira Sengoku, Nobuhisa Aoyagi, Yasutaka Kubota, Riki Matsumoto, Shinji Ohara, Takeharu Kunieda, Kaku Kimura, Jun Takahashi, Susumu Miyamoto, Hiroshi Shibasaki","doi":"10.1684/j.1950-6945.1999.tb00308.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.1999.tb00308.x","url":null,"abstract":"A clinically tonic seizure phase, immediately followed by psychomotor features (right hand dystonic posture, left hand and oral automatisms), was recorded by video and EEG, in a patient who had gliosis of the left temporal lobe and left hippocampal atrophy. Interictal epileptiform discharges were frequently seen in the left temporal area, and at the time of the tonic seizure phase, ictal spike discharges were continuously observed at the left posterior temporal area, which was recognized only by applying a high frequency filter (HFF) of 15 Hz to the digitally recorded EEG because EMG artifacts totally obscured the EEG with a HFF of 60 Hz. It is most likely that tonic seizure can occur in an adult patient with temporal lobe epilepsy, and it is speculated that an epileptogenic focus might activate a certain brain area which is regarded as a symptomatogenic zone for tonic seizures. If the tonic seizure phase is immediately followed by psychomotor features as seen in the present patient, the former could be due to focal epilepsy.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140312978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1684/j.1950-6945.1999.tb00328.x
A. Biraben, E. Sartori, D. Taussig, A.M. Bernard, J.M. Scarabin
We report scalp EEG and SPECT findings in a young patient who experienced gelastic seizures; clinical, EEG and scintigraphic data strongly suggested a frontal focus in a context of cryptogenic epilepsy. Few cases of gelastic seizures originating in the frontal lobe have been reported in the literature, most of them involving a diencephalic hamartoma or a temporal focus although, no clinical pattern has been found to be specific for each of these three anatomical regions. The ictal laughter is of variable nature, unmotivated or associated with feelings of mirth, forced or natural, except in the case of a frontal focus where the laughter seems consistently described as forced and unmotivated. However, mirth and laughter are two dissociable clinical elements; their genesis probably involves distinct mechanisms. Anatomical considerations lead to several hypotheses concerning laughter generation: it could be a simple reactional behavior in response to a modified cognitive process, an automatic behavior or a forced action. In a few cases with a temporal focus, laughter seems directly related to a disorganization of the associative temporal cortex and may be considered as a reactional behavior. In cases with frontal focus, anterior cingulate and orbital structures would be particularly implicated in laugher genesis, although with possible different pathophysiological routes: in the first case by disconnection within the premotor mesial system or by an imbalance between premotor mesial and premotor lateral systems, and in the second case by activation of a previously conditioned orbital region.
{"title":"Gelastic seizures: video‐EEG and scintigraphic analysis of a case with a frontal focus; review of the literature and pathophysiological hypotheses","authors":"A. Biraben, E. Sartori, D. Taussig, A.M. Bernard, J.M. Scarabin","doi":"10.1684/j.1950-6945.1999.tb00328.x","DOIUrl":"https://doi.org/10.1684/j.1950-6945.1999.tb00328.x","url":null,"abstract":"We report scalp EEG and SPECT findings in a young patient who experienced gelastic seizures; clinical, EEG and scintigraphic data strongly suggested a frontal focus in a context of cryptogenic epilepsy. Few cases of gelastic seizures originating in the frontal lobe have been reported in the literature, most of them involving a diencephalic hamartoma or a temporal focus although, no clinical pattern has been found to be specific for each of these three anatomical regions. The ictal laughter is of variable nature, unmotivated or associated with feelings of mirth, forced or natural, except in the case of a frontal focus where the laughter seems consistently described as forced and unmotivated. However, mirth and laughter are two dissociable clinical elements; their genesis probably involves distinct mechanisms. Anatomical considerations lead to several hypotheses concerning laughter generation: it could be a simple reactional behavior in response to a modified cognitive process, an automatic behavior or a forced action. In a few cases with a temporal focus, laughter seems directly related to a disorganization of the associative temporal cortex and may be considered as a reactional behavior. In cases with frontal focus, anterior cingulate and orbital structures would be particularly implicated in laugher genesis, although with possible different pathophysiological routes: in the first case by disconnection within the premotor mesial system or by an imbalance between premotor mesial and premotor lateral systems, and in the second case by activation of a previously conditioned orbital region.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140313010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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