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1019
Age a t
onset of
seizure
Seizure
and types
EEG
TABLE 1
Additional
clinical
findings
Neuropsychology
test
0 th er
laboratory
studies
Presumed
etiology,
pathology
IQ 94-87-90,
short attention
Astrocytoma, right
frontotemporal
(autopsy)
Laugh 9
Run 9
IQ 89-18-83
Angiogram, right
frontal mass
Prematurity
20
8
Psychomotor, Spike, left
grand mal
temporal
IQ 106-98-103
Hyperostosis,
frontalis;
PEG, negative
Head injury
Angiogram,
negative; PEG,
negative
Run 21
Grand m 4
Spike-and-wave, Stutter,
adversive,
left anterior
cataract
psychomotor, temporal
petit mal
IQ 98-86-89,
MMPI:schizo,
depression,
psychopathic
Angiogram
negative; PEG,
mild left
dilatation
Run
21
Run 12
Grand mal,
Sharpslow,
psychomotor bilateral
temporal
IQ 16-82-11,
left temporal
lobe dysfunction
Run
Status epilepticus
(twice)
Run 20
IQ 81-82-80,
MMP1:suspiciousness
Run 11
Psychomotor Spike-and-wave,
left anterior
temporal
16
35
22
21
11
24
24
Laugh 8
Run 8
Case
No. Age* Sex
h)
Case
N o . Age* Sex
Age a t onset
laughing
of running,
Laugh 8
Seizure
and types
TABLE 1 (continued)
EEC
Behavior problem
Addition a1
clinical
findings
Other
laboratory
siudies
PEG, negative
IQ 92-88-90,
PEG, negative
MMPI :depression,
anxiety, paranoid
Neuropsychology
test
!h
Laugh 2
12
Spike, left
anterior
temporal
Petit mal,
grand mal
10
Presumed
etiology,
pathology
Birth trauma
?
Birth trauma,
cerebral anomaly ?
Meningitis
Laugh 2
(Hyperactive,
retardation)
Head injury
Schizophrenia
Laugh 16
Measles
encephalopathy
13
IQ 34
Retardation,
hyperactive
11
34
10
Laugh 9
12
13
Niemann-Pick
disease
Head injury
Head injury,
left parieto-occipital,
arachnoid cyst, and
cortical atrophy
(operation)
Sociopathic
personality
Anemia
Grand mal,
Sharpslow,
psychomotor left temporal
Grand mal,
Spike, left
psychomotor temporal
IQ 61-60-56
Foamy cells,
liver, bone
marrow
Laugh 25
Laugh 42
25
15
Laugh 4
25
42
14
15
Ataxia,
pyramidal signs,
bilateral
IQ 90-103-96,
PEG and
MMP1:personality agiogram,
problems
left hemisphere
mass (?)
16
NEUROLOGY
1022
1023
Figure 1. P.S. (case I)had both gelastic and cursive epilepsy. EEG showed focal spikes in the right
hemisphere at the beginning of seizure attack, followed by generalized spike-and-slow waves and then
obliteration of the tracing by muscle artifacts. Pictures show the patient laughing (upper right) and
trying to get out of chair to run (lower right) during one of her seizure attacks, with simultaneous EEG
tracing attached.
for example, once he he ran into a box of jars his
mother was using for canning and sustained several
lacerations on his hands. He had no recall of what
he did during the episodes. He was given
diphenylhydantoin sodium and had complete
freedom from seizures for the first two years. He was
admitted at age 16 because of frequent seizures.
Physical and neurologic examinations were
unremarkable. EEG showed frequent paroxysmal
spike discharges more prominent in the left
hemisphere, with phase reversal in the left temporal
area. Neuropsychology testing revealed a full scale
IQ of 83. Pneumoencephalogram showed hypoplasia
of the entire left cerebral hemisphere. Carotid
arteriogram revealed shifting of midline vessels to
the left side and hypoplasia of left carotid system.
Primidone (Mysoline @) was added to his regimen.
Case 3. A case of running epilepsy is reported in
some detail here because of the completeness of
studies (including autopsy) plus the patient's peculiar
awareness of an evoking factor for his cursive component. LeRoy J., a 35 year old man had the onset of
major motor and psychomotor seizures at the age of
27. The seizures started with an uncinate aura of an
odor of gasoline followed by uncontrollable running
NEUROLOGY
1024
T3-Fp1
FpI-F3
Figure 2. L.J. (case 3) had F3-c3
cursive epilepsy. EEG shows
focal intermittent delta ac- C3-T3
tivity at right frontoternporal
region.
T4-Fp2
F p 2-F4
F4-C4
C4-T4
control. Neurologic examination revealed lethargy,
ataxia and diplopia. EEG revealed intermittent delta
activity of the right anterior temporal and frontal regions (figure 2a). Carotid arteriogram revealed
evidence o f a mass lesion anterior to the sella near
the midline hut more on the right. A grand ma1
seizure developed 14 hours after the angiogram; the
patient went into coma and died. Autopsy revealed a
large deep-seated astrocytonia, grade I to 4, in the
right frontal lobe with extension into the right temporal lobe and basilary cisterns, and extending
through corpus callosum and septuni pellucidum
into left mesial hemispheric structures (figure 3).
The EEG of patients i n cases 9 and 14 with an
Figure 3.
Autopsy
astrocytoma
totemporal
tension to
hemispheric
Discussion
1025
1 second
,5o uv
NEUROLOGY
1026
TABLE 2
ANATOMIC O R PATHOLOGIC LESIONS OF GELASTIC AND CURSIVE EPILEPSY
A uthor(s)
Gelastic epilepsy
Lesions
Suzuki'
'
'
Encephalitis
'
Pines'
'
Schneck'
Tay-Sachs disease
Mills'
'
Hypophyseal tumor
Hypophyseal tumor: basal aneurysm
Martin'
List and associates2
Money and Hostal
Ironside'
'
Lefebvre'
'
'
>'
'
Hamartoma of hypothalamus
Tumors in hypothalamus
Interpeduncular glioma
Cursive epilepsy
Lennox3
Pituitary adenoma
1027
TABLE 3
EEG FINDINGS OF GELASTIC AND CURSIVE EPILEPSY
A u tho@)
Gelastic epilepsy
Jaros3
Normal
Ironside'
'
Ede13'
Hypsarrhythmia
Lennox3'
'
Frontotemporal focus
'
Sharp waves in central regions and vertex; left frontotemporal paroxysmal abnormalities; left Rolandic spikes:
diffuse spikes-and-waves; diffuse slow waves; left anterior
spikes
Fourteen and six cycles per second positive spikes
Specific paroxysmal abnormalities in temporal, anterior
temporal or sylvian regions (eight of 10 patients); anterior
temporal slow waves (one of 10 patients); bioccipital spikes
and waves (one of 10 patients)
Strauss4
1028
NEUROLOGY
1029
23.
24.
2s.
26.
120:326, 1967
27. lronside R: Disorders of laughter due to brain lesions.
Brain 79589, 1956
2X. Focrster 0. Gagel 0 : Ein F a l l von Epcndymcyste des
111. Ventrikels, Z ges Neurol Psychiat 149:312, 1934
29. Gumpert J, Hansotia P, Upton A: Gelastic epilepsy. J
Neurol Ncurosurg Psychiiitr 33 479. I970
30. Jaros 0: Das Epileptische Lachen. Sborn vdd Praci l6k.
Fnk. Hradci Krdlovi I1:85. 19hX
31. Edel 0 : Uber Schlaf und Schlafanfhle in besonderer
Narkolepsie und traumatischer Epile sie mit Lachkrgmpfe. Zhl gcs Ncurcil Psychiatr 51:6?5, I Y O O
32. Lennox WG: Epilepsy and related diwrdcrs. VoI 1 .
Bnston. Little, Brown & Co.. 1Y60, p 2x0
33. Stein J, Dietze R: Electroencephalographic data in
geloplegia (Romanian) Neurologia (Bucur) 10:541,
I965
34. Roger J, Lob H, Waltregny A, et al: Attacks of epileptic
1;iughter on tive ciises. Electr~~cnccplial~,gr
C liii
Ncurophysiol 2?:27Y, I967
35. Zecchini A. Cccotto C: C'risi p;irossictichc di riso c di
pianto di iiatura epilepttic;i. Minerva Mcd 5X.3405.
I907