illustration of man in case study
Illustration by JABSOM 2nd year medical student Christina Tse.

Laughter is good medicine, except when it actually is the symptom of an illness. Medical residents at the University of Hawaiʻi at Mānoa John A. Burns School of Medicine (JABSOM) helped a man who suffered from nearly a lifelong affliction that caused him to laugh with no control over when it happened or why.

“This was a very medically intriguing case. Prior to this case, I didn’t know seizures could manifest in such a way as uncontrollable laughter,” said Nina Leialoha Beckwith, a family medicine resident at JABSOM who worked on the case with fellow residents under the supervision of JABSOM clinical professor Kore Kai Liow, neurologist and chief of staff-elect at Adventist Health Castle.

The case was academically compelling but also stirred great empathy in the physician trainees. The patient, 40 years old at the time, had suffered from the uncontrolled laughter since the age of eight.

Kore Kai Liow
Kore Kai Liow
Nina Beckwith
Nina Beckwith

“I believe his story can help us as clinicians to identify and provide better care for patients suffering from similar conditions,” said Beckwith. “I can only imagine what it is like for this patient to suffer from these bizarre seizures for so many years. I’m grateful to have been a part of his care.”

A rare form of epilepsy

As the physicians reported in the Hawaiʻi Journal of Medicine and Social Welfare, the medical term for the condition was a gelastic seizure. They wrote, “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,” non-cancerous tumors on the hypothalamus region of the brain. “GS have also been observed in patients with frontal and temporal lobe lesions.”

The man had a history of both a brain tumor and of diabetes mellitus and schizophrenia, in addition to the laughing fits, which struck two to three times a week. He had been considered by some to have longstanding behavioral issues. But when it came to the uncontrolled laughter, there was indeed a physical cause, and when the hypothalamic hamartoma was detected and the patient treated with medicine, the laughter was brought under control, according to Liow.

The researchers concluded that gelastic seizures need to be included in diagnosing patients with uncontrolled laughter. They wrote, “Thus, a thorough workup should include neuroimaging with attention to the suprasellar region and EEG or electroencephalogram. Accurate, early diagnosis and patient education are critical in avoiding excessive and unnecessary treatments.”

Learn more about this case on the JABSOM website.