Emotionalism is an heightened tendency to cry, or more rarely, laugh. It is commonly associated with brain damage and is often distressing to both patients and carers. Emotionalism is easily confused with depression, and when severe it can interfere with treatment. The aetiology is poorly understood but its response to drugs with different modes of action suggests that there is more than one underlying mechanism. When the components of emotionalism are studied separately a wide range is observed and they combine in a more complex and varied way than commonly held stereotyped views suggest. Most patients with emotionalism are helped by simple education and reassurance. Some severe cases respond dramatically to tricyclic antidepressants, levodopa or fluoxetine.

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Lambert-Eaton myasthenic syndrome (n = 14, three had coexisting cerebellar degeneration and six had SCC). It is noteworthy that non-organ-specific ANA were found in 33% of patients with Lambert-Eaton syndrome who had cancer (n = 50). Patients with this syndrome have a variety of autoantibodies.'°T his emphasises the necessity of retesting and titrating any serum that is positive for neuronal nuclear reactivity on substrates of neural and non-neural tissues side-by-side to confirm neuronal specificity. Immunoblot criteria have been used by some researchers to classify different types of anti-neuronal antibodies.9" However, our experience with the immunofluorescence screening procedure described above validates the clinical usefulness of a positive result obtained with this simple test. Seroaegativity does not exclude the presence of a malignant tumour. Occasionally atypical patterns of cerebellar staining are encountered, that is, not strictly fitting either of the two patterns described. At present no attempt is made to assign them clinical significance.