Fits of weeping as an unusual manifestation of reflex epilepsy induced by speaking: case report

We report the case of a 62-year-old man with no past CNS history who for some weeks had had fits of weeping that lasted from 30" to 3', precede by any aura; sensorium was clear; there were no symptoms of any kind after the paroxysm; in the course of them his facial expression was that of weeping with sobbing and tears, but no corresponding affective-emotional content, as reported by the patient, who was able to converse during these episodes. The fits were easily triggered by speaking. EEG during an episode showed a slight flattening of the trace, high voltage sharp waves at 4-6 c/s appeared, especially over the left hemisphere. CT brainscan and cerebral angiogram revealed a large space-occupying lesion of cystic-necrotic appearance with considerable mass effect and characteristics of glioblastoma. Treatment with barbiturates ended the paroxysmal weeping. We consider that these episodes were simple partial epileptic seizure according to the WHO classification of 1981.