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Open Access Highly Accessed Case report

Laugh-induced seizure: a case report

Naba Raj Mainali1*, Leena Jalota1, Madan Raj Aryal1, Torrey R Schmidt2, Madan Badal1 and Richard Alweis13

Author Affiliations

1 Department of Medicine, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA, 19611, USA

2 Department of Medicine, Robert Wood Johnson University Hospital, 10 Plum Street, New Brunswick, NJ, 08901, USA

3 Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA, 19107, USA

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Journal of Medical Case Reports 2013, 7:123  doi:10.1186/1752-1947-7-123

Published: 13 May 2013

Abstract

Introduction

A laugh-induced seizure is an unrecognized condition and to the best of our knowledge no case has been reported in the medical literature until now. We present an interesting and extremely rare case in which laughing generated the seizure activity that was recorded and confirmed by video electroencephalography.

Case presentation

A 43-year-old obese Caucasian man with history of bipolar disorder and chronic headache presented with multiple episodes of seizures, all induced by laughter while watching comedy shows. Each episode lasted approximately five seconds. In each instance, he started laughing, then his arms started shaking and he felt like ‘his consciousness was being vacuumed away’. A physical examination revealed normal findings. He had been maintained on valproic acid for bipolar disorder and topiramate for his chronic headache, but this did not control his symptoms. His sleep-deprived electroencephalography and brain magnetic resonance imaging were normal except for an arachnoid cyst measuring 4.2 × 2.1cm in the anterior right middle cranial fossa. His video electroencephalography demonstrated laugh-induced seizure activities. He was then placed on carbamazepine. Following treatment, he had two episodes of mild staring but no frank seizures, and his seizures have remained well controlled on this regimen for more than a year.

Conclusions

Laugh-induced seizure is a most unusual clinical entity without any previous case report. Confirmatory diagnosis can be made by video electroencephalography recording of seizure activities provoked by laughing. As in gelastic seizure without hypothalamic hamartoma, our case responded well to polytherapy with topiramate and carbamazepine on top of laugh-provocation avoidance. Further study is required to establish the standard treatment of this condition.

Keywords:
Laugh-induced seizure; Gelastic seizure; EEG; Cingulate gyrus; Topiramate; Carbamazepine