ICTAL LAUGHTER ASSOCIATED WITH PAROXYSMAL HYPOTHALAMOPITUITARY DYSFUNCTION

Purpose: Seizures with ictal laughter (also termed gelastic seizures) have been associated with hypothalamic hamartomas and precocious puber ty. It is not known, however, where in the brain such seizures origina te. We describe a child with gelastic seizures and a hypothalamic lesi on (probably a hamartoma) in whom two dysfunctional phenomena were obs erved. Results: First, there was a hyperperfusion in the hypothalamopi tuitary areas shown by ictal [(99m)]Te hexamethylpropyleneamine oxime (HM-PAO) single photon-emission computed tomography (SPECT). Second, t here was an ictal pulse of gonadotropins, 17 beta-estradiol, and growt h hormone well above the normal limits in one of the seizures. Conclus ion: These findings suggest that gelastic seizures associated with hyp othalamic hamartomas are generated in the hypothalamus or in its neigh boring regions and that these seizures may cause paroxysmal dysfunctio n of the hypothalamopitutary axis.