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+A 27 years old, male, right handed, was admitted for a 2 years history of very frequent gelastic seizures.
+The patient described aura–like symptoms: especially warmth throughout the face and dizziness that preceded the seizure and he denied any affective connotation.
+Some of the seizures consisted only of a brief period of laughter without any motor involvement, but a typical seizure would consist of sudden laughter accompanied by simple motor partial seizures in both arms, more often being involved his left arm, without impairment of his consciousness state, which lasted less than 1 minute.
+He had no previous past medical or social history other than being a smoker: 10–15 cigarettes per day.
+The frequency of the seizures was initially low, but increased progressively over time to about 8–10 seizures/day, despite anti–epileptic treatment – at the time of admission he was taking Keppra – Levetiracetam 3 x 250 mg/day and Phenytoin 3 x 100 mg/day.
+With the Neurology Electrophysiology Department assistance we have been able to record a couple of seizures on the Video–EEG His neurological examination was normal.
+Diagnosis was made on native CT scan: minimal hypodense frontal right paramedian lesion (Figure 1A), cerebral MRI (Figure 1 B–F) showed a small right parenchymal homogeneous lesion 16/22/15mm, well delimited, involving gyrus cinguli, without perilesional edema and mass effect, hyperintense both on T1 and T2 MR sequences, non–enhancing after Gadolinium.
+The cerebral lesion was also documented on EEG and video–EEG recordings: 3 seizures with medio–frontal origin and rare interictal epileptiform elements were recorded (Figure 1I)
+Using an interhemispheric microsurgical approach, above the corpus callosum and the right pericallosal artery, at the level of gyrus cinguli, a yellow–gray, infiltrative tumour, having a moderate vascularisation had been identified and totally removed.
+The anatomo–pathological analysis revealed a grade Ⅱ astrocytoma.
+The patient recovered very well, without deficits, no gelastic seizures or epileptic manifestations; three months after operation he is still free of seizures.
+A control postop CT revealed no tumor (1 G, H)