Restricted frontomesial epileptogenic focus generating dyskinetic behavior and laughter.
OBJECTIVE
Substantial data are missing about the anatomic location of frontal regions supporting gelastic seizures.


METHODS
We report the results of stereo-electro-encephalographic recordings performed over several distinct functional premotor and executive fields in a patient whose seizures were characterized by dyskinetic behavior and ictal laughter, in the absence of cerebral MRI abnormalities.


RESULTS
The epileptogenic zone was circumscribed in the anterior and ventral part of the supplementary motor area and the underlying dorsal cingulate cortex. There were no or little spreading to cortical neighboring areas. The patient is seizure-free (follow-up of 27 months) after a stereotactic electric radiofrequency lesion of the epileptogenic focus.


CONCLUSIONS
The present data suggest that pericingulate premotor areas are involved in the triggering of the motor component of laughter. In this case, the coexistence of paroxysmal dyskinesias during laughter might reflect the involvement of specific compartment(s) of the basal ganglia.
Chassagnon
Serge
S
Service de Neurologie, Neuropsychologie et explorations fonctionnelles des épilepsies, hospices civils de Strasbourg, Strasbourg, France.
Minotti
Lorella
L
Kremer
Stephane
S
Verceuil
Laurent
L
Hoffmann
Dominique
D
Benabid
Alim Louis
AL
Kahane
Philippe
P
D000328:Adult; D001479:Basal Ganglia / Q000503:physiopathology; D020820:Dyskinesias / Q000175:diagnosis* / Q000503:physiopathology; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods* / Q000706:statistics & numerical data; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000503:physiopathology*; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D007845:Laughter / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology; D013238:Stereotaxic Techniques