Gelastic epilepsy is a convulsive disease and its main symptom is uncontrollable and involuntary laughter. It isn’t a well-known condition, except for those interested in the recently released movie Joker. In it, the plot plays with the possibility that the protagonist suffers from this disease. So, what are the causes, symptoms, and treatment for gelastic epilepsy?
Gelastic epilepsy was first diagnosed in 1957, when scientists Daly and Mulder published a research paper about it. The article appeared in the journal Neurology and laid the foundations for this condition.
The term ‘gelastic’ comes from the Greek word meaning ‘laughter.’ The symptom of spontaneous laughter, even in situations where one shouldn’t laugh, is what separates this type of epilepsy from others.
This uncontrollable and involuntary laughter isn’t the result of a joke or a funny situation. In reality, many patients relate their laughing episodes to sadness and not feelings of joy or pleasure.
This shows how uncomfortable this condition is for people who suffer from it, and that these aren’t just laughing attacks. Patients understand that what they’re doing is inappropriate, but they aren’t able to stop themselves. In addition, it’s impossible for people with this condition to stop themselves from laughing in the first place.
Gelastic epilepsy is more common in men than in women. However, its incidence is very low, approximately 0.2%. This means that for every thousand people, there may be two who suffer from this disease. Usually, this disease shows up between three and four years old.
Causes of gelastic epilepsy
Gelastic epilepsy could be an atypical form of seizure as a response to little-known genetic mechanisms, or mechanisms of neuronal connections. Also, there’s an underlying cause that has been associated with hypothalamus tumors.
Two types of tumors can develop in the hypothalamus: hamartomas and astrocytomas. While these tumors tend to be benign, their slow but sustained growth presses on structures that result in different symptoms.
As benign tumors, neither hamartomas nor astrocytomas metastasize. Neither do they invade the hypothalamus’ neighboring organs.
Different diagnoses
Laughter from gelastic epilepsy creates a challenge for clinicians in terms of diagnoses. That’s because inappropriate and uncontrollable laughter isn’t necessarily a type of seizure. It can also be due to other diseases.
For example, with people on drugs or alcohol, it’s possible that you’ll see laughter that’s similar to that of gelastic epilepsy. Obviously, the laughter isn’t chronic in these cases because it’s triggered by consumption. That’s the key point in differentiating one condition from the other.
There’s also a syndrome known as Angelman that has laughter as a symptom. This is a disabling genetic alteration. In Angelman syndrome, there’s a noticeable developmental delay. From six months on, parents may notice that their child has nervous system problems.
Lastly, the condition that may cause the most confusion is pseudobulbar palsy. The way to differentiate between this and gelastic epilepsy is that, with pseudobulbar palsy, the laughter shows up in people who suffer from another underlying disorder. For example, this may be the case with Parkinson’s disease.
Symptoms of gelastic epilepsy
We’ve already mentioned that the main symptom of gelastic epilepsy is laughter, but we’ll repeat it again. It’s important to note that this laughter isn’t like other laughter. In fact, it has special characteristics that make it different and unique.
Laughter associated with gelastic epilepsy lasts less than a minute. Also, it appears and disappears suddenly. The laughter is involuntary and the patients can’t stop themselves because they have no control over it.
In addition to the laughter, you may also experience the classic symptoms associated with seizures. Some of these symptoms include movements through muscle spasms, momentary loss of consciousness, and sphincter relaxation. These symptoms can persist even after the laughter ends.
If a child suffers from gelastic laughter and develops signs of precocious puberty, it’s very likely that there’s a hamartoma growing in the hypothalamus. Precocious puberty is when children show signs of adolescence before the age of eight or nine.
Treatment for gelastic epilepsy
The treatment for gelastic epilepsy is with the same medications that doctors prescribe for seizures. Among them are carbamazepine, lamotrigine, topiramate or levetiracetam, as well as others.
Controlling the affected person’s laughing isn’t easy to do. Unfortunately, treatment is never effective enough. Laughing attacks occur cyclically, deeply affecting the patients’ quality of life.
Despite the difficulties associated with this disease, it’s important to know that a lot of progress has been made in anti-epileptic drug research. In addition, many groups of professionals in the world today are more knowledgeable about the disease and are better trained to treat it.
