{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:29:27Z","timestamp":1788535767881,"version":"build-2803163510"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017959","name":"Health Commission of Hebei Province","doi-asserted-by":"publisher","award":["20240528"],"award-info":[{"award-number":["20240528"]}],"id":[{"id":"10.13039\/100017959","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"\n Background<\/jats:title>\n Repetitive transcranial magnetic stimulation (rTMS) is a well-established neuromodulation technique for post-stroke motor rehabilitation with a favorable safety profile. However, its safety in patients with acute\/subacute cerebral infarction remains incompletely characterized, particularly regarding unusual behavioral responses. Gelastic seizures, characterized by stereotyped, inappropriate laughter without a corresponding emotional trigger, are a rare form of focal epilepsy typically associated with hypothalamic hamartomas or other structural brain lesions. Their induction by rTMS has been exceptionally reported.<\/jats:p>\n <\/jats:sec>\n \n Case presentations<\/jats:title>\n We report two cases of acute ischemic stroke in right-handed middle-aged males who developed stimulus-locked ictal laughter during low-frequency (1\u00a0Hz) rTMS applied to the left primary motor cortex (M1) for upper limb rehabilitation. Case 1 was a 48-year-old male with right temporo-parieto-occipital infarction who developed recurrent, uncontrollable ictal laughter during the third rTMS session. The laughter was site-specific and reproducible, elicited only when the coil was positioned over the left M1 and ceasing upon repositioning to the prefrontal area. Post-stimulation video-electroencephalography (VEEG) with bipolar montage analysis revealed sporadic single sharp waves over the right anterior temporal (F8), bilateral dorsolateral prefrontal cortex (F3, 4) during wakefulness. Seven months later, upon re-challenge, the patient promptly reported an urge to laugh, leading to immediate cessation. Case 2 was a 42-year-old male with a right lacunar infarct in the globus pallidus and internal capsule who developed ictal-like laughter during the fifth rTMS session, preceded by a premonitory urge to laugh during the fourth session. Consciousness was fully preserved in both patients, and each reported post-ictal dysphoria. Discontinuation of rTMS resulted in complete symptom resolution, with no recurrence at follow-up.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n To our knowledge, this is the first report of rTMS-induced ictal laughter in stroke patients. These observations expand the spectrum of rTMS-associated adverse effects, challenge the assumption that low-frequency protocols are uniformly safe in the post-stroke population, and underscore the need for clinical vigilance in patients with structural brain lesions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1925476","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:11:17Z","timestamp":1788534677000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ictal laughter induced by repetitive transcranial magnetic stimulation in stroke patients: a case series"],"prefix":"10.3389","volume":"17","author":[{"given":"Shusheng","family":"Jiao","sequence":"first","affiliation":[{"name":"Department of Neurology, Bethune International Peace Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuhong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bethune International Peace Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e316-436","DOI":"10.1161\/STR.0000000000000513","article-title":"2026 guideline for the early management of patients with acute ischemic stroke: a guideline from the american heart association\/american stroke association","volume":"57","author":"Prabhakaran","year":"2026","journal-title":"Stroke"},{"key":"B2","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.clinph.2019.11.002","article-title":"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rtms): an update (2014-2018)","volume":"131","author":"Lefaucheur","year":"2020","journal-title":"Clin Neurophysiol Off J Int Fed Clin Neurophysiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.09.008","article-title":"The use of repetitive transcranial magnetic stimulation for stroke rehabilitation: a systematic review","volume":"27","author":"Dion\u00edsio","year":"2018","journal-title":"J Stroke Cerebrovascular Dis Off J Natl Stroke Assoc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2009.08.016","article-title":"Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research","volume":"120","author":"Rossi","year":"2009","journal-title":"Clin Neurophysiol Off J Int Fed Clin Neurophysiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.neuroscience.2026.03.017","article-title":"High-frequency rtms mitigates acute sleep deprivation-induced anxiety-like behaviors and working memory impairments associated with hippocampal transcriptional modulation","volume":"602","author":"Sun","year":"2026","journal-title":"Neuroscience"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2019.03.012","article-title":"Efficacy and safety of high-frequency repetitive transcranial magnetic stimulation for poststroke depression: a systematic review and meta-analysis","volume":"100","author":"Liu","year":"2019","journal-title":"Arch Phys Med Rehabil"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2024.123069","article-title":"Effects and safety of high-frequency rtms in subacute ischemic stroke patients","volume":"462","author":"Komatsu","year":"2024","journal-title":"J Neurol Sci"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2007.06.016","article-title":"Safety study of high-frequency transcranial magnetic stimulation in patients with chronic stroke","volume":"118","author":"Lomarev","year":"2007","journal-title":"Clin Neurophysiol Off J Int Fed Clin Neurophysiol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2147\/ndt.s2173","article-title":"Gelastic seizures associated with hypothalamic hamartomas. An update in the clinical presentation, diagnosis and treatment","volume":"4","author":"T\u00e9llez-Zenteno","year":"2008","journal-title":"Neuropsychiatr Dis Treat"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1055\/a-2561-8410","article-title":"Combined gelastic and dacrystic seizures in a child with hypothalamic hamartoma","volume":"56","author":"Kronast","year":"2025","journal-title":"Neuropediatrics"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s12519-023-00763-1","article-title":"Neural network mapping of gelastic behavior in children with hypothalamus hamartoma","volume":"20","author":"Guo","year":"2024","journal-title":"World J Pediatr WJP"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2021.106713","article-title":"Successful stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of a patient with mesial frontal region-originated mirthful gelastic seizure","volume":"207","author":"Huaqiang","year":"2021","journal-title":"Clin Neurol Neurosurg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v12.i20.4440","article-title":"Temporal lobe malacia as a rare cause of gelastic seizure: a case report","volume":"12","author":"Liao","year":"2024","journal-title":"World J Clin cases"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/epd2.70152","article-title":"Pediatric gelastic seizures with parietal origin: evidence from imaging and surgical outcome","volume":"28","author":"Wu","year":"2026","journal-title":"Epileptic Disord Int Epilepsy J Videotape"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.4103\/0028-3886.333525","article-title":"Mri-negative occipital lobe epilepsy presenting as gelastic seizures","volume":"69","author":"Hu","year":"2021","journal-title":"Neurol India"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2017.03.005","article-title":"Gelastic seizures caused by subtle focal cortical dysplasia in the inferior frontal gyrus: three case reports","volume":"376","author":"Zhou","year":"2017","journal-title":"J Neurol Sci"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.70731","article-title":"A case report of high-dose repetitive transcranial magnetic stimulation-induced excessive laughing in a 6-year-old boy with autism spectrum disorder","volume":"13","author":"Long","year":"2025","journal-title":"Clin Case Rep"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2023.04.027","article-title":"Non-invasive brain stimulation techniques for the improvement of upper limb motor function and performance in activities of daily living after stroke: a systematic review and network meta-analysis","volume":"104","author":"Ahmed","year":"2023","journal-title":"Arch Phys Med Rehabil"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1111\/cns.12762","article-title":"Effectiveness of repetitive transcranial magnetic stimulation (rtms) after acute stroke: a one-year longitudinal randomized trial","volume":"23","author":"Guan","year":"2017","journal-title":"CNS Neurosci Ther"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2015.06.033","article-title":"Can low-frequency repetitive transcranial magnetic stimulation precipitate a late-onset seizure in a stroke patient","volume":"127","author":"Kumar","year":"2016","journal-title":"Clin Neurophysiol Off J Int Fed Clin Neurophysiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s13643-025-02794-3","article-title":"Repetitive transcranial magnetic stimulation for motor function in stroke: a systematic review and meta-analysis of randomized controlled studies","volume":"14","author":"Xie","year":"2025","journal-title":"Syst Rev"},{"key":"B22","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1007\/s00415-026-13912-z","article-title":"Systematic review and meta-analysis of the efficacy of repetitive transcranial magnetic stimulation on post-stroke limb spasticity","volume":"273","author":"Huang","year":"2026","journal-title":"J Neurol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.yebeh.2014.03.024","article-title":"Different localizations underlying cortical gelastic epilepsy: case series and review of literature","volume":"35","author":"Tran","year":"2014","journal-title":"Epilepsy Behav E&B"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebcr.2015.07.001","article-title":"Gelastic epilepsy: beyond hypothalamic hamartomas","volume":"4","author":"Uribe-San-Martin","year":"2015","journal-title":"Epilepsy Behav Case Rep"},{"key":"B25","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1093\/cercor\/bhaa264","article-title":"Two neural networks for laughter: a tractography study","volume":"31","author":"Gerbella","year":"2021","journal-title":"Cereb Cortex (New York NY 1991)"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1037\/emo0000237","article-title":"A mirror mechanism for smiling in the anterior cingulate cortex","volume":"17","author":"Caruana","year":"2017","journal-title":"Emotion (Washington DC)"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2009.03.004","article-title":"Gelastic seizures: a case of lateral frontal lobe epilepsy and review of the literature","volume":"15","author":"Kovac","year":"2009","journal-title":"Epilepsy Behav E&B"},{"key":"B28","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.yebeh.2014.06.012","article-title":"Gelastic epilepsy without hypothalamic hamartoma: three additional cases","volume":"37","author":"Savasta","year":"2014","journal-title":"Epilepsy Behav E&B"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.neucli.2025.103125","article-title":"Clinical and neurophysiological effects of rtms on chronic post-stroke hand spasticity","volume":"56","author":"Guerrero Solano","year":"2026","journal-title":"Neurophysiol Clin Clin Neurophysiol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2023.11.019","article-title":"High-frequency rtms of the left dorsolateral prefrontal cortex for post-stroke depression: a systematic review and meta-analysis","volume":"157","author":"Wang","year":"2024","journal-title":"Clin Neurophysiol Off J Int Fed Clin Neurophysiol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2026.117244","article-title":"Efficacy and safety of low-frequency repetitive transcranial magnetic stimulation in post-stroke depression: a fnirs pilot study","volume":"363","author":"Fan","year":"2026","journal-title":"Psychiatry Res"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.64898\/2026.06.01.26354398","article-title":"Improving motivation in post-stroke apathy with repetitive transcranial magnetic stimulation (impart): a phase-i pilot trial","volume":"2026","author":"Seidman","year":"2026","journal-title":"medRxiv Preprint Server For Health Sci"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1925476\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:11:19Z","timestamp":1788534679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1925476\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":32,"alternative-id":["10.3389\/fpsyt.2026.1925476"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1925476","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"article-number":"1925476"}}