Oehl Bernhard, Biethahn Silke, Schulze-Bonhage Andreas
Epilepsy Center, University Hospital Freiburg, Germany.
Epileptic Disord. 2009 Mar;11(1):82-6. doi: 10.1684/epd.2009.0245. Epub 2009 Mar 20.
Ictal laughter is the cardinal clinical sign of gelastic seizures in hypothalamic hamartomas and may also occur in extrahypothalamic epilepsies. Laughing consists of an affective and a motor component. It has been suggested that the affective component may result from an involvement of temporobasal structures, whereas the motor part is related to an involvement of the mesial frontal cortex. So far, evidence is based on a limited number of cases with spontaneously recorded seizures or in whom electrical stimulation of invasive intracranial EEG recordings has been performed. We report a patient who suffered from epigastric psychic auras, complex partial seizures with a gelastic component and secondarily generalized seizures. To evaluate a possible epileptogenic role of the hippocampus and dysplastic region in the right mid-temporal gyrus, intracranial monitoring with subdural electrodes over the temporobasal and temporolateral regions, as well as a deep brain electrode in the hippocampus, were performed. During the intial part of the seizure, consisting of an intense retrosternal ascending feeling with sexual connotation, rhythmic spikes in temporolateral contacts were detected. Concomitant with the development of smiling and laughter, a rhythmic activity over the temporobasal regions evolved. The patient became seizure-free following right temporal lobe resection. This case supports the assumption that ictal involvement of temporobasal structures is crucial for gelastic seizure components in patients with temporal lobe epilepsy. Progression to temporobasal regions was associated with the feeling of happiness whereas motor components of laughter occurred later. These findings are in accordance with the interpretation of surface recordings by Dericioglu and co-workers in a similar previous case. [Published with video sequences].
发笑性癫痫是下丘脑错构瘤中痴笑性癫痫发作的主要临床症状，也可能发生于下丘脑外癫痫。发笑由情感和运动成分组成。有人提出情感成分可能源于颞叶底部结构受累，而运动部分与内侧额叶皮质受累有关。到目前为止，证据基于少数自发记录发作的病例或进行了有创颅内脑电图记录电刺激的病例。我们报告了一名患有上腹部精神性先兆、伴有痴笑成分的复杂部分性发作和继发性全身性发作的患者。为了评估海马体和右侧颞中回发育异常区域可能的致痫作用，在颞叶底部和颞外侧区域使用硬膜下电极进行颅内监测，并在海马体中植入深部脑电极。在发作初期，患者有强烈的胸骨后上升感并伴有性意味，此时在颞外侧触点检测到节律性棘波。随着微笑和发笑的出现，颞叶底部区域出现节律性活动。该患者在右颞叶切除术后无癫痫发作。此病例支持这样的假设，即颞叶癫痫患者中，颞叶底部结构的发作期受累对于痴笑性癫痫发作成分至关重要。向颞叶底部区域的进展与幸福感相关，而发笑的运动成分出现较晚。这些发现与Dericioglu及其同事在之前一个类似病例中对表面记录的解释一致。[随视频序列发表]
