Pathologic Laughter Research Articles

Treatment of Poststroke Pathologic Laughing With Duloxetine: A Case Series.

Pathologic laughing is characterized by episodes of uncontrollable laughter caused by underlying neurologic disturbances, such as stroke. Several types of medication, including selective serotonin reuptake inhibitors, have demonstrated only limited success at treating the condition. Duloxetine, a dual serotonin-norepinephrine reuptake inhibitor, is reportedly effective in treating the symptoms of mood disorders. We herein introduce a prospective consecutive sample of stroke patients with pathologic laughing treated with duloxetine. We enrolled patients without a history of psychological illness who exhibited poststroke pathologic laughter. Duloxetine administration was commenced at an initial dose of 30 mg once daily. The dose was increased to 60 mg once daily within 2 weeks for all patients except 2. The effect of the treatment was assessed by means of the Pathological Laughter and Crying Scale. A total of 7 patients were included in the study. Improvements were observed within an average of 10 days after duloxetine administration. Pathological Laughter and Crying Scale score decreased after duloxetine administration in all patients, and 4 patients demonstrated a decrease in score of more than 50%. All patients reported subjective improvement of symptoms, and no adverse effects were observed. This case series demonstrates that duloxetine could attenuate pathologic laughing exhibited by stroke patients; however, further randomized controlled studies are necessary to validate our findings.

Transient Mutism and Pathologic Laughter in the Course of Cerebellitis

The phenomenon of cerebellar mutism with subsequent dysarthria is most commonly described as a part of posterior fossa syndrome after surgery for neoplasms in childhood. Pathologic laughter, on the other hand, is observed primarily in various neurologic diseases in adults. In the present case, a child manifested transient mutism and pathologic laughter during a severe cerebellitis. Headache, vertigo, and impaired consciousness developed during an acute respiratory infection. Thereafter, severe ataxia, mutism, and involuntary laughter became the main clinical features, as well as pyramidal signs. Magnetic resonance imaging revealed cerebellar swelling and T(2) hyperintensity. During steroid treatment, a gradual vanishing of the pathologic laughter and improvement of the motor and speech functions occurred. Recovery was slow and incomplete, and follow-up magnetic resonance imaging showed cerebellar atrophy. This case confirms that mutism is a rare, but possible, manifestation in acute parainfectious cerebellitis and provides a novel example of pathologic laughter during this disease in childhood.

Management of Pathologic Laughter and Crying in Patients With Locked-In Syndrome: A Report of 4 Cases

Sacco S, Sarà M, Pistoia F, Conson M, Albertini G, Carolei A. Management of pathologic laughter and crying in patients with locked-in syndrome: a report of 4 cases. Emotional lability and pathologic laughter and crying (PLC) have been frequently mentioned in patients with locked-in syndrome (LIS) without giving any detail about the clinical characteristics and possible consequences in terms of symptoms burden, functional impact, and recovery. In the present report, we describe our approach and management of 4 patients with LIS and PLC. PLC caused discomfort to the patients and hindered the different components of their rehabilitation program, limiting communication, the execution of swallowing testing and training, and the improvement of any residual motor function. PLC was unrelated to depression, did not ameliorate after pharmacologic treatment, and improved with cognitive-behavior treatment. Our findings suggest that, in LIS patients, laughter and crying alterations do not represent symptoms of a mood disorder but are the result of the same pontine lesion that causes LIS. In relation to the complex pathway regulating laughter and crying, we hypothesized that, in patients with LIS, PLC may be the result of a direct damage to the pontine center or of an alteration in the ponto-cerebellar pathway linking emotional behavior to contextual information. Presence of PLC in patients with LIS severely affects their intelligent adaptation to the environment. Direct explanation to the patients of the origin of PLC may be helpful as a cognitive-behavior treatment, with resulting benefits to the entire rehabilitation program.

Du rire aux larmes: Pathological laughing and crying in patients with traumatic brain injury and treatment with lamotrigine

Pathologic laughter and crying (PLC) is the involuntary occurrence of laughter and crying in the absence of a corresponding change in affect. PLC resulting from structural brain damage in patients with traumatic brain injury can be the cause of substantial social dysfunction in these patients. The use of lamotrigine as an antiepileptic drug and mood stabilizer is well established; its use in PLC has been reported only once during treatment following a stroke. We present here four young patients with pathological laughter and/or pathological crying following traumatic brain injury who were successfully treated with lamotrigine. Data supporting the use of lamotrigine in the treatment of PLC following traumatic brain injury and the neuroanatomy of pathological laughing are briefly reviewed.

Stimulus-induced pathologic laughter due to basilar artery dissection

Laughter is considered pathologic when involuntary and inappropriate. Pathologic laughter may be seen in many neurologic disorders, including gelastic epilepsy, posterior fossa space-occupying lesions, demyelinating diseases, and pontine or hemispheric infarcts (bulbar and pseudobulbar palsy).1 We report a patient with pathologic laughter occurring prominently on swallowing, associated with basilar artery dissection and pseudoaneurysm. A 33-year-old man with a history of atrial fibrillation was admitted after two episodes of dizziness, diplopia, dysarthria, ataxia, left hemiparesis, and circumoral numbness. MRI showed bilateral pontine infarctions. MR angiography (MRA) revealed a dolichoectatic basilar artery, with partial thrombosis anterior to the left pons. Angiography demonstrated basilar artery dissection. He was discharged on warfarin. Symptoms improved over 3 months. Two months later, during a funeral, he first experienced involuntary, inappropriate laughter. Episodes of laughter continued, 10 times daily, lasting 1 minute. Swallowing liquids, but not solids, routinely triggered laughter. Other triggers included unfamiliar situations (being in a hospital or public place) and …

Postictal laughter following absence status epilepticus

Acute pathologic neurologic laughter has been described as an ictal phenomenon in epilepsy, as a result of electrical brain stimulation to the cortex and to deep brain structures, in brain tumors, and in stroke. We report what is, to our knowledge, the first report of a case of postictal pathologic laughter. Previously diagnosed with medically refractory complex partial seizures, our patient was admitted to the hospital with phenytoin toxicity. During video-EEG monitoring she experienced multiple brief absence seizures as well as a prolonged episode of absence status epilepticus. Immediately following cessation of the seizure she began to laugh. Her laughter was mirthful and infectious. This lasted several minutes and was followed immediately by several minutes of crying and then a return to normal. We propose that diffuse cortical inhibition led to release of subcortical structures involved in emotional expression. Possible neural substrates of laughter are discussed.

Trigeminal Neurinomas

The surgical management issues of 73 cases of trigeminal neurinoma treated over a 12-year period were analyzed. The case records and radiologic material of 73 patients with trigeminal neurinoma operated on in the Neurosurgery Department at King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, between the year 1989 and 2001 were retrospectively analyzed. The appropriateness of the selected surgical route is studied. Apart from the other typical presenting features of trigeminal schwannoma, 9 patients presented with the rarely reported symptom of pathologic laughter. Three approaches were found appropriate to treat these tumors: the infratemporal fossa interdural approach, the lateral basal subtemporal approach, and the retrosigmoid approach. In 51 (69.9%) cases, total tumor excision was achieved. Two patients died during the postoperative period. During an average follow-up of 38 months, there has been a recurrence in 1 case and 71 patients are leading an independent and active life. Radical surgery is associated with an excellent clinical outcome and long-term tumor control. A majority of tumors, even those that are large and multicompartmental, can be removed in a single surgical stage and exposure.

Pathologic laughter resulting from a large midbrain arteriovenous malformation

Movement DisordersVolume 14, Issue 1 p. 185-189 Clinical/Scientific Notes Pathologic laughter resulting from a large midbrain arteriovenous malformation† Sundus H. Alusi MRCP, Sundus H. Alusi MRCP Division of Neurosciences and Psychological Medicine, Imperial College School of Medicine, London, U.K.Search for more papers by this authorIan Colquhoun FRCS, FRCR, Ian Colquhoun FRCS, FRCR Department of Radiology, Charing Cross Hospital, London, U.K.Search for more papers by this authorTom Sensky FRCPsych, PhD, Tom Sensky FRCPsych, PhD Division of Neurosciences and Psychological Medicine, Imperial College School of Medicine, West Middlesex University Hospital, Middlesex, U.K.Search for more papers by this authorPeter G. Bain FRCP, MD, Corresponding Author Peter G. Bain FRCP, MD Department of Neurology, West Middlesex University Hospital, Middlesex, U.K.Department of Neurosciences, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, U.K.Search for more papers by this author Sundus H. Alusi MRCP, Sundus H. Alusi MRCP Division of Neurosciences and Psychological Medicine, Imperial College School of Medicine, London, U.K.Search for more papers by this authorIan Colquhoun FRCS, FRCR, Ian Colquhoun FRCS, FRCR Department of Radiology, Charing Cross Hospital, London, U.K.Search for more papers by this authorTom Sensky FRCPsych, PhD, Tom Sensky FRCPsych, PhD Division of Neurosciences and Psychological Medicine, Imperial College School of Medicine, West Middlesex University Hospital, Middlesex, U.K.Search for more papers by this authorPeter G. Bain FRCP, MD, Corresponding Author Peter G. Bain FRCP, MD Department of Neurology, West Middlesex University Hospital, Middlesex, U.K.Department of Neurosciences, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, U.K.Search for more papers by this author First published: 22 January 2001 https://doi.org/10.1002/1531-8257(199901)14:1<185::AID-MDS1041>3.0.CO;2-2Citations: 3 † A videotape accompanies this article. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume14, Issue1January 1999Pages 185-189 RelatedInformation

Basilar artery occlusion associated with pathological crying:'Folles larmes prodromiques'?

Pathologic laughter heralding a catastrophic brainstem cerebro-vascular event was first described by Fere, who labeled the phenomenonfou rire prodromique.1 Clinical, radiologic, and pathologic studies of subsequent cases have shown lesions in the internal capsule and thalamus, basal ganglia, hypothalamus, and ventral pons.2-4 I report a patient with a basilar artery occlusion associated with pathologic crying. Case report. An 18-year-old woman had a sudden onset of vomiting and loss of feeling on the left side of her face and body. She became progressively less responsive verbally but was noted to be crying continuously. The unremitting weeping without obvious cause prompted her mother to wonder whether the crying was hysterical; she therefore slapped her daughter's face, but the weeping continued unchanged. The patient had increasing difficulty walking, requiring assistance from family members. The patient had occasional migraine headaches (as did her mother) and was taking oral contraceptives; she smoked cigarettes occasionally, but there …

Pathologic laughter after unilateral stroke

Pathologic laughter which usually occurs after bilateral or diffuse cerebral lesions was rarely reported in patients with unilateral stroke. I describe clinical and radiological findings of 13 patients presenting pathologic laughter due to unilateral stroke. Their laughter was excessive, unmotivated, uncontrollable and most often occurred during conversation especially at the initiation of speaking. There usually was a latent period between the onset of stroke and occurrence of the pathologic laughter. The degree and duration of the pathologic laughter varied, but its severity tended to diminish during the follow up. Some of them also had emotional instability evidenced by easy weeping. Imaging studies showed that 12 patients had infarcts and one had a haemorrhage. The lesions were located in the lenticulocapsular area in 8, pontine base in 3, thalamocapsular area in 1, and cerebral cortical–subcortical area in one. The lenticulocapsular stroke usually involved the upper part of the basal ganglia and a genu or an anterior portion of the posterior limb of the internal capsule/corona radiata. In conclusion, unilateral, usually subcortical, strokes can produce pathologic laughter. Although the neuroradiological data presented here generally support the motor release hypothesis, the delayed onset symptoms suggest that more complex mechanisms may be involved.

Pathologic Laughter in Children

Pathologic Laughter in Children

Normal and Pathologic Laughter in Children

Laughter is a partly involuntary act involving complex pathways in the central nervous system. Laughter normally has positive effects on emotions; however, pathologic laughter is not related to emotion and occurs independent of a stimulus in the environment. This paper outlines normal laughter and the etiology of pathologic laughter, considering both congenital and acquired causes.

Pathologic laughter and crying in ALS: a search for their origin.

Spells of laughter and crying are well known in patients with amyotrophic lateral sclerosis (ALS). Since ALS occurs mostly in older age groups, this brings up the possibility that aging changes in the brain could play a causative role in the origin of such spells. To rule out or at least reduce the complicating factor of aging, a study was made of the incidence of pathologic laughter and crying in patients whose motor neuron disease had started before the age of 45 years. The data were collected from 73 such individuals, all with confirmed ALS. All told, 36 had experienced episodes of pathologic laughter and/or crying. Of these, 20 had bouts of both laughter and crying. 9 bouts of crying alone and 7 spells of laughter alone. Nearly all with such emotional spells had developed bulbar involvement with the illness. The youngest patient with spells was 31 when his illness began and 35 when he started to have bouts of crying.