Laughter in the cockpit: gelastic seizures--a case report

We present a case of gelastic seizures in a student naval aviator. He was noted to have uncontrollable fits of laughter on several occasions, but was not referred to his flight surgeon until he had a gelastic seizure while flying in formation, which jeopardized the safety of the flight. He had an aura consisting of lack of concentration, which was then followed by 10 s or less of hysterical laughter. For the previous year and a half, he had had frequent episodes of nocturnal laughter so loud that he woke members of his household and occasionally himself. His neurological evaluation was normal, except for an electroencephalogram (EEG) and a separate video recording, which documented the ictal nature of his events. Gelastic seizures have not previously been discussed in the literature of aerospace medicine. This case illustrates a rare condition that should be considered in patients presenting with inappropriate laughter, and serves as a reminder of the need for continuous, ongoing evaluation of all aircrew by the cognizant flight surgeon.