Pathological Laughing As a Manifestation in a Clinically Isolated Brainstem Syndrome: A Case Report

Koçer, Belgin; Oner, Yusuf; Batur, Hale; Nazlıel, Bijen; Çengiz, Bülent; Tali, Turgut

doi:10.1111/j.1552-6569.2008.00281.x

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…This analysis showed that compared with those without PLC, people with MS with PLC had fewer lesions in the posterior fossa when controlling for depressive symptoms. Compared with previous work implicating brainstem and cerebellum lesions in PLC, 2,12,13,20,21 the present results are not in line with the predicted hypothesis; however, they provide insight and further our understanding of the underpinnings of PLC. The present results suggest that lesion localization alone, specifically, in the posterior fossa, is insufficient to predict the development of PLC in people with MS.…”

Section: Discussioncontrasting

confidence: 99%

Posterior Fossa Lesion Load and Pathological Laughing and Crying in Multiple Sclerosis

Luhoway¹,

Sharma²,

Menon³

et al. 2019

International Journal of MS Care

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CME/CNE Information Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Accreditation Statement: In support of improving patient care, this activity has been planned and implemented by the Consortium of Multiple Sclerosis Centers (CMSC) and Delaware Media Group. The CMSC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Physician Credit The CMSC designates this journal-based activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Credit The CMSC designates this enduring material for 0.75 contact hour (none in the area of pharmacology). Disclosures: Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has disclosed relationships with Springer Publishing (royalty); Biogen (speakers' bureau); GW Pharma, Abide Therapeutics (consulting fee); and Adamas Pharmaceuticals (contracted research).Francois Bethoux, MD, has served as reviewer for this activity. She has disclosed no relevant financial relationships.Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.Jacqueline A. Luhoway, MD, has disclosed no relevant financial relationships.Manas Sharma, MD, has disclosed relationships with Roche, EMD Serono, Sanofi (consulting fee); and Roche (contracted research).Suresh Menon, MD, has disclosed no relevant financial relationships.Heather Rosehart, BScH, has disclosed relationships with Biogen, EMD Serono, Novartis, Roche, and Sanofi Genzyme (consulting fee, speakers' bureau, contracted research).Sarah A. Morrow, MD, MS, FRCPC (Neurology), One peer reviewer for IJMSC has disclosed relationships with Actelion, Bayer HealthCare, Biogen, Celgene, Chugai, Clene Nanomedicine, EMD Canada, Genzyme, Merck Serono, Novartis, F. Hoffman-La Roche, Pendopharm, Sanofi-Aventis, Teva Canada (consulting fee); Sanofi Genzyme (speakers' bureau); Genzyme Canada (contracted research); and Actelion, Bayer HealthCare, Biogen, Clene Nanomedicine, F. Hoffman-La Roche, Merck Serono, MedDay, Novartis, Sanofi-Aventis (advisory board, board of directors, or other similar group). The other peer reviewer has disclosed no relevant financial relationships. The staff at IJMSC, CMSC, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Note: Financial relationships for some authors may have changed in the interval between listing these disclosures and publication of the article. Method of Participation: Release Date: June 1, 2019 Valid for Credit Through: June 1, 2020 In order to receive CME/CNE credit, participants must: Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.

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Section: Discussioncontrasting

confidence: 99%

Posterior Fossa Lesion Load and Pathological Laughing and Crying in Multiple Sclerosis

Luhoway¹,

Sharma²,

Menon³

et al. 2019

International Journal of MS Care

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“…PLC in multiple sclerosis is the result either of isolated lesions to specific areas of the brain (in medulla oblongata and the mesencephalon [ 54 ], clinically isolated syndrome with pontine lesion [ 55 ]) or the consequence of an extensive diffuse involvement of the brain especially of the prefrontal cortex producing a complex neuropsychological impairment [ 56 – 58 ].…”

Section: Discussionmentioning

confidence: 99%

Pathological laughter as prodromal manifestation of transient ischemic attacks—case report and brief review

et al. 2015

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BackgroundBased on a case report, the authors reviewed the data about involuntary emotional expression disorder (IEED). IEED includes the syndromes of pathological laughing and crying (PLC) and emotional lability (EL). PLC is a rare disorder of emotional expression characterized by relatively uncontrollable episodes of laughter and crying or both that do not have an apparent motivating stimulus.Case presentationAuthors report the case of a 59-year-old man who presented with recurrent episodes of PLC of approximately 2 min duration, consisting of accelerated breathing, emission of guttural, snoring sounds, frowning of the eyebrows, followed by laughter accompanied by motor restlessness of all four limbs. PLC episodes preceded left carotid transient ischemic attacks (TIA’s) manifested by reversible aphasia and right hemiparesis. Electroencephalography performed during PLC episodes revealed no spike-wave activity. Brain magnetic resonance imaging showed lacunar infarcts in the left lenticulo-capsulo-thalamic area and multiple round lesions in the cortical-subcortical and in the deep white matter of frontal-parietal-occipital lobes bilaterally, with T2 hyperintensity, T1 isointensity and no diffusion changes. The episodes were interpreted as transient ischemic attacks although gelastic seizures could not be excluded. The etiological investigations revealed unstable plaques on the left carotid artery bulb and the aortic arch and a degenerative mitral valve stenosis. The patient was treated first with antiplatelet therapy and antiepileptic drugs but PLC stopped only after anticoagulation was started. During follow-up the patient continued to have left carotid and vertebrobasilar TIA’s being on oral anticoagulation. The patient became asymptomatic only after mitral valve replacement was performed.ConclusionsThis case illustrates the difficulty distinguishing between gelastic epilepsy and TIA’s in cases of PLC episodes and discuss the neuroanatomic bases and pathophysiology of this rare condition.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0457-3) contains supplementary material, which is available to authorized users.

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“…The occurrence of PBA has been reported in a multitude of neurologic illnesses including, but not limited to, ALS, [15][16][17][18][19] PD and other movement disorders, 13,[20][21][22] MS, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] stroke, [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] various types of dementia and other neurodegenerative disorders, 55-62 traumatic brain injury (TBI), 63-66 central nervous system tumors, [67][68][69][70][71][72][73][74]...…”

Section: Epidemiologymentioning

confidence: 99%

The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

King¹,

Reiss²

2013

DNND

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Pseudobulbar affect is a disorder resulting from neurologic damage manifesting as sudden, stereotyped affective outbursts that are not reflective of internal emotion. A literature review was completed to examine the current understanding of the epidemiology, characterization, diagnosis, pathophysiology, and treatment of pseudobulbar affect. This review revealed that it is common in neurodegenerative disorders but is poorly recognized, placing significant impacts on patients and their families. The disorder appears to result from a disruption of the cortico-limbicsubcortical-thalamic-pontocerebellar network involved in emotional expression and regulation with resulting disruptions of neurotransmitter systems. Effective treatment is available with agents such as selective serotonin reuptake inhibitors and dextromethorphan combined with quinidine, but further well-designed comparative studies are needed. Advances in technology such as neuroimaging may enhance knowledge about the pathophysiology of this disorder, and help guide future interventions.

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Pathological Laughing As a Manifestation in a Clinically Isolated Brainstem Syndrome: A Case Report

Cited by 7 publications

References 13 publications

Posterior Fossa Lesion Load and Pathological Laughing and Crying in Multiple Sclerosis

Posterior Fossa Lesion Load and Pathological Laughing and Crying in Multiple Sclerosis

Pathological laughter as prodromal manifestation of transient ischemic attacks—case report and brief review

The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

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