EHS
EHS

Gelastic attack in a child with moyamoya disease

A 7-year-old girl presented with paroxysms of transient laughter accompanied by right limb weakness, followed by crying. She was diagnosed with moyamoya disease (figure 1). Interictal 123I-IMP-SPECT showed decreased cerebral blood flow in multiple areas including the frontal lobe and cingulate gyrus (figure 1). All the paroxysms of laughter occurred without unconsciousness and appeared only after hyperventilation during crying (video). EEG revealed no epileptiform discharge in the ictal state (figure 2). After bilateral revascularization, the paroxysms did not reappear. These attacks had behavioral features consistent with ischemia or epilepsy, the former being more likely.1,2

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