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Merchán-Del-Hierro X, Fernandez-Boccazzi J, Gatto EM. Why is the Joker Laughing? Clinical Features for the Differential Diagnosis of Pathological Laughter. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:512-516. [PMID: 33884584 DOI: 10.1007/s40596-021-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
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Zhang LP, Jia Y, Huang H, Li DW, Wang YP. Clinical Classifications of Children With Psychogenic Non-epileptic Seizure. Front Pediatr 2020; 8:596781. [PMID: 33569360 PMCID: PMC7868414 DOI: 10.3389/fped.2020.596781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/31/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: To analyze the clinical features of children with psychogenic non-epileptic seizures in one tertiary center in China. Methods: Clinical data including medical records and video- electroencephalograph (video-EEG) monitoring records of 88 pediatric PNES patients hospitalized in the pediatric department of Xuanwu Hospital, Beijing, China from April, 2012 to April, 2018 were collected in this study. Demographic information of patients, semiological classification, duration, and frequency of symptoms, risk factors as well as comorbidity were summarized and analyzed. Results: For semiological classification, all PNES related symptoms were divided into different categories: motor symptoms, unresponsiveness, sensory symptoms, visceral symptoms, and abnormal behaviors, among which motor symptoms were the most prevalent form. Risk factors were reviewed and categorized into two groups: persistent factors and predisposing factors, and patients were most frequently affected by the influences of families. The duration and frequency of symptoms varied substantially within PNES patients while the average time of duration was relatively longer than epilepsy as reported previously. Epilepsy was considered as the most frequent comorbidity of PNES and PNES patients misdiagnosed as epilepsy often mistreated with antiseizure medication. Significance: Our study showed that motor PNES are the most frequent seizure type. Family issues were a risk factor for PNES. Epilepsy was the most frequent co-existing neurological comorbidity.
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Affiliation(s)
- Li-Ping Zhang
- Department of Pediatric, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hao Huang
- Medical Records and Statistics Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Da-Wei Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu-Ping Wang
- Department of Pediatric, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Beckwith NL, Khil JC, Teng J, Liow KK, Smith A, Luna J. Inappropriate Laughter and Behaviours: How, What, and Why? Case of an Adult with Undiagnosed Gelastic Seizure with Hypothalamic Hamartoma. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2018; 77:319-324. [PMID: 30533284 PMCID: PMC6277842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Gelastic seizures (GS) are a rare form of epilepsy characterized by inappropriate, uncontrolled laughter. They are highly associated with abnormal cognitive development and behavioral problems in patients. Research has shown that GS can originate from hypothalamic hamartomas (HH), non- neoplastic masses consisting of gray matter with large and small neurons interspersed with glial nuclei. GS have also been observed in patients with frontal and temporal lobe lesions. The patient in this case report is a 40-year-old man with a past medical history significant for brain tumor, diabetes mellitus, and schizophrenia who presented with a long standing history of sudden, involuntary laughter occurring 2-3 times a week since 8 years old. Since the onset of these laughing spells the patient has displayed gradual cognitive impairment and increasing behavioral problems. Subsequent EEG (21-channel electroencephalogram) showed focal epileptiform activity in the right frontotemporal region and MRI studies revealed a mass arising from the hypothalamus suggestive of a HH. Other conditions should be considered in the differential diagnosis for laughing spells and distinguishing different causes can be challenging. As demonstrated by this case report, in patients with behavioral issues, especially those with inappropriate uncontrolled laughter, gelastic seizures need to be included in the differential diagnosis. Thus, a thorough workup should include neuroimaging with attention to the suprasellar region and EEG. Accurate, early diagnosis and patient education are critical in avoiding excessive and unnecessary treatments. This condition may be pharmacoresistant and is often associated with progressive cognitive and behavioral issues. Studies have shown a surgical treatment approach may be effective.
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Affiliation(s)
- Nina L Beckwith
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (NLB,JCK,AS)
- The University of Adelaide, Adelaide, South Australia, Australia (JS)
- Comprehensive Epilepsy Center, Hawai'i Pacific Neuroscience, Honolulu, HI (KKL,JL)
| | - Jaclyn C Khil
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (NLB,JCK,AS)
- The University of Adelaide, Adelaide, South Australia, Australia (JS)
- Comprehensive Epilepsy Center, Hawai'i Pacific Neuroscience, Honolulu, HI (KKL,JL)
| | - Jason Teng
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (NLB,JCK,AS)
- The University of Adelaide, Adelaide, South Australia, Australia (JS)
- Comprehensive Epilepsy Center, Hawai'i Pacific Neuroscience, Honolulu, HI (KKL,JL)
| | - Kore K Liow
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (NLB,JCK,AS)
- The University of Adelaide, Adelaide, South Australia, Australia (JS)
- Comprehensive Epilepsy Center, Hawai'i Pacific Neuroscience, Honolulu, HI (KKL,JL)
| | - Alice Smith
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (NLB,JCK,AS)
- The University of Adelaide, Adelaide, South Australia, Australia (JS)
- Comprehensive Epilepsy Center, Hawai'i Pacific Neuroscience, Honolulu, HI (KKL,JL)
| | - Jesus Luna
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (NLB,JCK,AS)
- The University of Adelaide, Adelaide, South Australia, Australia (JS)
- Comprehensive Epilepsy Center, Hawai'i Pacific Neuroscience, Honolulu, HI (KKL,JL)
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Sheth SA, Chandra NC, Mehta RY. Temporal Lobe Seizures Presenting as Abrupt Clinging Behavior in a Child. Indian J Psychol Med 2017; 39:527-530. [PMID: 28852255 PMCID: PMC5560009 DOI: 10.4103/0253-7176.211761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
True and psychogenic nonepileptic seizures (PNES) go hand in hand. One colors the picture of other. Although it is thought that children carry lower risk for PNES than adults, this may represent the under-diagnosis of this condition in childhood due to few studies on this specific topic. Again, true seizure can be misdiagnosed by dramatic and varied manifestations appearing as psychological phenomena. We report a case of a 9-year-old boy presenting with sudden onset, short lasting, off and on different "melodramatic" episodic behavioral problems with La-Belle' indifference without loss of consciousness, appearing to be of psychogenic origin but finally ended with a diagnosis of temporal lobe epilepsy and responded dramatically with antiepileptics. The goal of this case report is to alert the reader to be cautious about rarer presentations of epilepsy and see each case holistically which may be misguided as PNES.
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Affiliation(s)
- Shabina A Sheth
- Department of Psychiatry, Government Medical College and New Civil Hospital, Surat, Gujarat, India
| | - Nilanjan C Chandra
- Department of Psychiatry, Government Medical College and New Civil Hospital, Surat, Gujarat, India
| | - Ritambhara Y Mehta
- Department of Psychiatry, Government Medical College and New Civil Hospital, Surat, Gujarat, India
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