Doctors at Kamineni Hospitals performed a rare surgery on 3-year-old Grace, who was taken to the hospital at LB Nagar by her parents with a developmental disorder, unusual episodes of laugh called Gelastic seizures. Gelastic seizures are usually present in childhood, even in the newborn period, and are manifested by frequent attacks of inappropriate laughter resulting from seizure activity. Studies show that Gelastic seizures are very rare and only one in every 200,000 children suffers from this abnormality.
Grace used to have bought of laughter i.e, suddenly, the child laughs for no obvious reason, situation or cause. The child was evaluated when she had abnormal laugh diagnosed to have gelastic seizure found to have sub centimetre lesion in the hypothalamus most probably hypothalamic hamartoma and started on anti-seizure medications. Parents went around the hospitals for treatment with a futile result.
6 months ago child used to get seizures once a month and it was lasting for 10 seconds, but now the frequency of seizures increased to 5- 6 times a day and increasing the duration of seizures to 1 minute. The child also developed a new-onset squint in the Left eye. In our hospital, she was evaluated with a team of doctors i.e, Neurosurgeon, Neuro physician, Paediatrics and Endocrinologists. She underwent imaging (MRI brain plain and contrast) in high end 3T MRI which showed a large lesion extending from hypothalamus (which is a part of the brain that houses a number of small nuclei that undertake a variety of functions) with compression on major vessels and nerves (especially to vision and extra ocular movements). Endocrinologists diagnosed the child to have reached puberty stage (corresponding to 8 years of age) because neurons in the tumour function as a heterotopic hormone (GnRH ) pulse generator.
“Child parents have been explained about the condition, rarity of disease requirement of surgery and risk involved. Parents were explained about other modalities of treatment. After thorough counselling, the child was taken for craniotomy and excision of the tumour using Navigation under general anaesthesia. Having Navigation in our armentarium helped us to do surgery in a minimally invasive manner without disturbing major structures especially nerves responsible for vision, extraocular movements and vessels. Post-surgery the frequency of seizures has significantly come down. ” said Dr. Ramesh Consultant Neurosurgeon, Minimal Access brain and spine surgeon, Kamineni Hospitals, Hyderabad.
“The most common areas of the brain which give rise to gelastic seizures are the hypothalamus that regulates the pituitary gland. A common cause of gelastic epilepsy is a small tumour in the hypothalamus. The majority of such tumours are benign. Children with hypothalamic hamartomas usually have gelastic seizures, cognitive malfunction, behavioural disorders. Early identification, proper diagnosis and management would help children to have better outcomes” Dr. Ramesh added.
The child’s parents had taken Grace to many hospitals but did not receive proper treatment. They are happy with the treatment given to Grace at Kamineni Hospitals.
