Umeoka Shuichi, Baba Koichi, Mihara Tadahiro
Department of Neurological Surgery, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
Neurosurgery. 2008 Dec;63(6):E1205-6; discussion E1206. doi: 10.1227/01.NEU.0000335169.86155.65.
A rare case of orbitofrontal lobe epilepsy manifesting gelastic seizure is reported.
A 49-year-old woman had developed weekly complex partial seizures consisting of nonverbal vocalization and unresponsiveness followed by laughter. Magnetic resonance imaging revealed a round tumorous lesion at the posterior side of the right rectal gyrus and medial orbitofrontal gyrus. Neuroimaging studies and electrophysiological examinations, including intracranial electroencephalographic monitoring, suggested the existence of an epileptogenic zone in the ipsilateral orbitofrontal gyrus, including the lesion.
After partial right prefrontal lobectomy including lesionectomy, the patient became seizure-free during a follow-up period of 33 months. We speculated that the limbic system, including the orbitofrontal lobe and temporal structures, which have a strong connection with the pontine nuclei, might be involved in this patient's gelastic seizure.
Except for impaired consciousness, the clinical manifestations did not correspond to the characteristics of orbitofrontal seizure described by the International League Against Epilepsy. Symptomatic laughter in epilepsy that originates from the orbitofrontal lobe is very rare. Intracranial electroencephalographic findings and ictal symptomatology associated with epileptogenesis in this rare case are discussed.
报告1例表现为痴笑发作的眶额叶癫痫罕见病例。
一名49岁女性出现每周一次的复杂部分性发作，发作时表现为非言语发声、无反应，随后大笑。磁共振成像显示右侧直回后部和眶额内侧回有一个圆形肿瘤样病变。神经影像学研究和电生理检查，包括颅内脑电图监测，提示同侧眶额回包括病变部位存在致痫灶。
行包括病变切除术的右侧前额叶部分切除术，术后随访33个月，患者无癫痫发作。我们推测，包括眶额叶和颞叶结构在内的与脑桥核有紧密联系的边缘系统可能与该患者的痴笑发作有关。
除意识障碍外，临床表现与国际抗癫痫联盟描述的眶额叶癫痫特征不符。起源于眶额叶的癫痫性症状性大笑非常罕见。本文讨论了该罕见病例中与癫痫发生相关的颅内脑电图检查结果和发作期症状学。
