 derives from the greek word 
 gelos ( laughter ) and was introduced in 1957 by daly 
 and mulder .
it is used to name seizures characterized by sudden laughter 
 attacks , out of social context , without any particular emotion like joy or 
 happiness . in 1971 , 
 gascon and lombroso suggested as diagnostic criteria the presence of stereotyped 
 laughter episodes in the absence of external triggers that can be associated 
 with other epileptic manifestations , ictal or interictal discharges on the 
 electroencephalogram ( eeg ) , and absence of other conditions that could explain 
 the pathologic laughter .
the vast majority of gelastic epilepsy series reported 
 include only children , and they have found an association with hypothalamic 
 hamartomas , a lesion that therefore must be always ruled out in these patients . 

however , other lesions and localizations have also been reported , mainly in 
 other adult patients , , . here
, we describe three patients with gelastic 
 seizures ( gs ) with no evidence of hypothalamic hamartomas .
a 35-year - old man with a history of neurocysticercosis was 
 treated with antiparasitic drugs as a teenager . since the age of 29  years , he had almost daily spells characterized by sudden 
 unmotivated laughter attacks which were described by his relatives since the 
 patient was not aware .
in addition , he had occasional seizures which started 
 with forced head version towards the right , followed by right upper and 
 lower limb jerks , and finally secondary generalization .
magnetic 
 resonance imaging ( mri ) showed upper right and inferior left mesial frontal 
 lobe nodular lesions , consistent with calcified neurocysticercosis 
 ( fig . 

five gs were 
 recorded on scalp video - eeg monitoring , all of them showing ictal patterns 
 arising from the left anterior temporal lobe ( fig .
positron emission tomography 
 ( pet ) was performed , showing left mesial frontal and anterior temporal 
 hypometabolism ( fig . 

invasive 
 recordings were performed with left frontal deep electrodes and foramen 
 ovale electrodes , and ictal and interictal activities arising from the left 
 mesial frontal region was demonstrated ( fig .
resection of the left frontal 
 pole , which included the lesion , was performed ( fig .
the patient has been seizure - free since the surgery ( 5  years of follow - up ) and under no medication for 3  years ( ilae class i ) . a 45-year - old man with epilepsy since the age of 14  years had seizures characterized by sudden laughter attacks , 
 associated with feelings of joy and happiness , which lasted about 30  s , occasionally associated with disconnection followed by one 
 to two minutes of postictal confusion .
he had up to 5 episodes per day in 
 spite of multiple antiepileptic treatments ( carbamazepine , phenobarbital , 
 levetiracetam , and topiramate ) .
2a ) ; surface eeg 
 recordings showed left frontotemporal interictal epileptiform discharges 
 ( fig .
2b ) ; two 
 gelastic seizures with left frontotemporal ictal onset were recorded . 

neuropsychological evaluation showed bilateral 
 mesial and anterior temporal alterations with predominance of the left 
 hemisphere .
the patient 
 remained seizure - free for a year , and seizures relapsed afterwards , with a 
 50% reduction compared to presurgical average ( ilae class iv ) .
old , he experienced brief laughter attacks , apparently unmotivated , 
 that was perceived as strange behavior by his family .
gelastic epilepsy was 
 diagnosed , and the patient was placed on carbamazepine ; the treatment was 
 stopped after a seizure - free period of 6  years .
five years 
 after the medication withdrawal , he began again with episodes of unmotivated 
 laughter , with no emotional correlate , associated with disconnection . 

carbamazepine was restarted with 
 complete control of the spells except during a few poor adherence 
 periods .
a 35-year - old man with a history of neurocysticercosis was 
 treated with antiparasitic drugs as a teenager . since the age of 29  years , he had almost daily spells characterized by sudden 
 unmotivated laughter attacks which were described by his relatives since the 
 patient was not aware .
in addition , he had occasional seizures which started 
 with forced head version towards the right , followed by right upper and 
 lower limb jerks , and finally secondary generalization .
magnetic 
 resonance imaging ( mri ) showed upper right and inferior left mesial frontal 
 lobe nodular lesions , consistent with calcified neurocysticercosis 
 ( fig . 

five gs were 
 recorded on scalp video - eeg monitoring , all of them showing ictal patterns 
 arising from the left anterior temporal lobe ( fig .
positron emission tomography 
 ( pet ) was performed , showing left mesial frontal and anterior temporal 
 hypometabolism ( fig . 

invasive 
 recordings were performed with left frontal deep electrodes and foramen 
 ovale electrodes , and ictal and interictal activities arising from the left 
 mesial frontal region was demonstrated ( fig .
resection of the left frontal 
 pole , which included the lesion , was performed ( fig .
the patient has been seizure - free since the surgery ( 5  years of follow - up ) and under no medication for 3  years ( ilae class i ) .
a 45-year - old man with epilepsy since the age of 14  years had seizures characterized by sudden laughter attacks , 
 associated with feelings of joy and happiness , which lasted about 30  s , occasionally associated with disconnection followed by one 
 to two minutes of postictal confusion .
he had up to 5 episodes per day in 
 spite of multiple antiepileptic treatments ( carbamazepine , phenobarbital , 
 levetiracetam , and topiramate ) .
2a ) ; surface eeg 
 recordings showed left frontotemporal interictal epileptiform discharges 
 ( fig .
2b ) ; two 
 gelastic seizures with left frontotemporal ictal onset were recorded . 

neuropsychological evaluation showed bilateral 
 mesial and anterior temporal alterations with predominance of the left 
 hemisphere .
the patient 
 remained seizure - free for a year , and seizures relapsed afterwards , with a 
 50% reduction compared to presurgical average ( ilae class iv ) .
a 42-year - old man had no relevant medical history . at 15 
 years old , he experienced brief laughter attacks , apparently unmotivated , 
 that was perceived as strange behavior by his family .
gelastic epilepsy was 
 diagnosed , and the patient was placed on carbamazepine ; the treatment was 
 stopped after a seizure - free period of 6  years .
five years 
 after the medication withdrawal , he began again with episodes of unmotivated 
 laughter , with no emotional correlate , associated with disconnection . 

carbamazepine was restarted with 
 complete control of the spells except during a few poor adherence 
 periods .
gelastic seizures are seen in less than 1% of all epilepsies 
 , and they are 
 mainly associated with hypothalamic hamartomas in children . usually , these 
 seizures begin during infancy , even in the neonatal period , with a progressive 
 course which may include other focal or generalized seizures .
invasive eeg recordings and electrical stimulation have 
 shown that gelastic seizures originated from the hypothalamic hamartomas , 
 although they can arise from other lesions , like tumors , malformations of 
 cortical development , tuberous sclerosis , and postinfectious foci . to the best of our knowledge , 

this is the first report of neurocysticercosis related to gs . in patients who have gelastic seizures without an impairment of 
 consciousness
, laughter is described as unmotivated or emotion - free , which could 
 be interpreted as a dissociation between the motor and emotional components of 
 laughter , although the physiological basis of joy and laughter are not fully 
 understood .
one of 
 them had a lesion in the left superior mesial frontal region and experienced gs 
 not accompanied by joy .
ictal subdural recordings showed that the seizures began 
 in the left anterior cingulate gyrus .
the other two patients had complex partial 
 seizures originating from the temporal lobe ; in these cases , electrical 
 stimulation of the fusiform and parahippocampal gyri produced bursts of laughter 
 accompanied by a feeling of mirth .
the authors concluded that the anterior 
 cingulate region is involved in the motor aspects of laughter , while the basal 
 temporal cortex is involved in the processing of joy .
these findings are also 
 consistent with a case described by coria et al .   in a patient who had a right lateral 
 basal temporal lesion and experienced joy associated with gelastic 
 seizures
intracranial 
 recordings and cortical electrical stimulation have shown involvement of the 
 mesial and lateral superior frontal , cingulate and orbitofrontal gyri 
 .
interestingly , 
 in a case studied by chassagnon et al .   with stereo - eeg , a nonlesional patient became 
 seizure - free after radiofrequency stimulation , resulting in two distinct lesions 
 in the left superior frontal and cingulate gyri . in our first patient ,
gs were associated with motor signs but 
 not with emotion , therefore suggesting a frontal lobe origin .
although the 
 surface eeg showed left anterior temporal ictal onset , both the mri and pet 
 showed left mesial frontal and anterior temporal changes .
invasive eeg 
 recordings localized the left mesial frontal lobe as the ictal onset area , which 
 was assumed to be the probable epileptogenic area , which was confirmed by the 
 good surgical outcome . in the second case , the structural and functional neuroimaging 
 and the surface eeg were consistent with a temporal origin of the seizures .
this 
 patient had , during the seizure , a sense of joy , similar to the cases reported 
 by iwasa et al . 
 which originated from the right or left mesial 
our 
 patient initially reached seizure - freedom for a year , although a long - term 
 reduction of 50% compared to presurgical status was finally reached .
this was 
 probably due to an incomplete resection of a cortical dysplasia associated with 
 the hippocampal sclerosis .
unlike the previous cases , our last patient had unremarkable 
 imaging or eeg findings and responded well to antiepileptic drugs . although 
 there were no ictal recordings that could confirm the topographical origin of 
 the seizures , a hypothalamic onset is unlikely . since the patient has had 
 complete seizure control with antiepileptic drugs , further studies were not 
 indicated
although gelastic epilepsy has been associated with hypothalamic 
 hamartomas in children , other localizations , including frontal and temporal lobe 
 foci , are more frequent among adult patients , .
gelastic epilepsy is usually 
 refractory , and surgery may be a useful tool , as reported in two of our 
 cases .
 gelastic epilepsy or laughing seizures have been 
 historically related to children with hypothalamic hamartomas . 
 we report three 
 adult patients who had gelastic epilepsy , defined as the presence of seizures 
 with a prominent laugh component , including brain imaging , surface / invasive 
 electroencephalography , positron emission tomography , and medical / surgical 
 outcomes . 
 none of the patients had hamartoma or other hypothalamic lesion . 
 two 
 patients were classified as having refractory epilepsy ( one had biopsy - proven 
 neurocysticercosis and the other one hippocampal sclerosis and temporal cortical 
 dysplasia ) . 
 the third patient had no lesion on mri and had complete control with 
 carbamazepine . 
 both lesional patients underwent resective surgery , one with 
 complete seizure control and the other one with poor outcome . 
 although 
 hypothalamic hamartomas should always be ruled out in patients with gelastic 
 epilepsy , laughing seizures can also arise from frontal and temporal lobe foci , 
 which can be surgically removed . 
 in addition , we present the first case of 
 gelastic epilepsy due to neurocysticercosis . 
Introduction
Case 1
Case 2
Case 3
Discussion
Conclusions
Conflict of interest