Refractory Temporal Gelastic Seizure: A Case Report

Abstract

Gelastic seizures are rare epileptic events characterized by sudden, unprovoked bursts of laughter that are typically associated with hypothalamic hamartomas but may also arise from cortical epileptogenic foci. We report the case of an eight-year-old boy born prematurely at 28 weeks’ gestation who presented with a two-year history of recurrent hypermotor seizures, loss of consciousness, behavioral arrest, falls, and frequent episodes of inappropriate laughter. Video electroencephalography demonstrated epileptiform activity consistent with left temporal lobe epilepsy with mild diffuse encephalopathy, while a 1.5 Tesla brain magnetic resonance imaging (MRI) showed no structural abnormality. Clinical evaluation also revealed mild microcephaly and learning difficulties. Initial treatment with carbamazepine followed by combination therapy with levetiracetam failed to adequately control seizures. However, seizure frequency improved after substitution of levetiracetam with lamotrigine. This case highlights that gelastic seizures may originate from the temporal lobe even in the absence of hypothalamic hamartoma and may be resistant to first-line therapy. Awareness of this rare presentation may facilitate earlier recognition and optimization of treatment strategies in affected patients.