Tuber Cinereum Hamartomas and Gelastic Epilepsy

Abstract

We studied five patients with gelastic epilepsy sustained by hamartoma of the tuber cinereum, submitted to EEG and Video-EEG study and to MR examination. The mechanism of ictal laughter, clinical associations and prognosis for seizure control are discussed. Hamartomas should be always suspected when gelastic seizures occur, and appropriate diagnostic tools should be employed for their diagnosis. In patients presenting with gelastic epilepsy, MR assessment of the hypothalamic region is necessary to identify a hamartoma of the tuber cinereum. Moreover, the resolution of MR imaging provides a basis to correlate some of the clinical manifestations with the anatomical disposition of the lesion within the hypothalamus. Gelastic epilepsy seems to correlate with large broad-based hamartomas in relationship with the mamillary bodies. In these cases, surgical treatment should be considered when symptoms are not sufficiently responsive to medical therapy.