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We describe a case of pathological laughter after gamma knife thalamotomy which resolved after treatment with sertraline. It is important to identify this potentially treatable complication of surgical therapy.
High-frequency stimulation of the subthalamic nucleus (STN) improves the motor signs of Parkinson's disease (PD). The three main components (motor, associative, and limbic) of the cortical-basal ganglia-cortical circuits pass through the STN. It is not known whether STN stimulation can influence the limbic loop. We present two PD patients in whom acute stimulation of an electrode located in the STN using high stimulation parameters (50% higher than therapeutic) induced funny associations, leading to infectious laughter and hilarity, whereas the therapeutic parameters induced a hypomanic behavior and marked improvement of akinesia. Our report suggests that the STN, with its sensorimotor, cognitive, and limbic parts is not only involved in motor, but also in psychomotor regulation.
Pseudobulbar affect is a condition characterized by uncontrollable episodes of inappropriate laughing or crying that are disproportionate and discordant to the situation at hand. We report on a 16-year-old woman presenting with acute pathological laughter in the context of CNS demyelinating disease. Brain MRI scans fortuitously obtained before and after the onset of this symptom demonstrated acute gadolinium-enhancing lesions in the cerebral peduncles. The etiology of this condition remains theoretical; however, the results here provide further insights into the pathways of emotional control.
A 69-year-old woman presented right hemiparesis accompanied by pathological laughter ("fou rire prodromique"). The right hemiparesis progressed over several days and MRI revealed a left pontine infarct caused by basilar artery stenosis which was demonstrated by MRA.
Children with pontine glioma usually present classically with ataxia, motor deficits and cranial nerve palsies. The pons has generally not been regarded as a structure that mediates complex affective behaviour. However, we report nine children who either at the time of presentation or progression demonstrated marked behavioural changes manifesting as either "pathological laughter" or separation anxiety in the form of school refusal. A mechanism of how pontine lesions can cause such complex affective and cognitive behaviour has been suggested to consist of the disruption of a network of cerebro-ponto-cerebellar pathways and the evidence for this mechanism is discussed.
Patients with right hemisphere strokes sometimes vehemently deny their paralysis. I describe three new experiments that were designed to determine the extent and depth of this denial. Curiously, when asked to perform an action with their paralyzed arm, they often employ a whole arsenal of grossly exaggerated 'Freudian defense mechanisms' to account for their failure (e.g. 'I have arthritis' or 'I don't feel like moving it right now'). To explain this, I propose that, in normal individuals, the left hemisphere ordinarily deals with small, local 'anomalies' or discrepancies by trying to impose consistency in order to preserve the status quo. But when the anomaly exceeds threshold, a 'devil's advocate' in the right hemisphere intervenes and generates a paradigm shift, i.e. it results in the construction of a new model using the same data. A failure of this process in right hemisphere stroke would partially explain anosognosia. Also, our model provides a new theory for the evolutionary origin of self-deception that is different from one proposed by Trivers. And, finally, I use anosognosia as a launching-off point to speculate on a number of other aspects of human nature such as Freudian defense mechanisms, laughter, dreams and the mnemonic functions of the hippocampus.
OBJECTIVES: Cataplexy, when unequivocally present together with excessive daytime sleepiness, is diagnostic for narcolepsy. Unfortunately, it is difficult to induce cataplexy during consultation. In this study we tried to assess presumed subclinical expressions of cataplexy using neurophysiological tests. METHODS: In this controlled explorative study, we studied 14 patients with a clear history of cataplexy and 12 matched controls using standard H-reflex, H/M ratios, audiospinal reflex, H-reflexes modulated by emotions and startle reflexes. RESULTS: H-reflexes were attenuated during laughter in patients as well as controls. Startle reflexes were increased in patients. Audiospinal reflexes were not influenced. CONCLUSIONS: The patterns found add relevant knowledge concerning pathophysiological mechanisms and involved brain areas in cataplexy, and may reflect subclinical expressions of cataplexy. The presumed specificity of the abolishment of H-reflexes during cataplectic attacks is questioned by our findings. The exaggerated startle reflex is in line with recent findings concerning involved brain areas in narcolepsy.
A case of trochlear nerve neurinoma in a 48-year-old women is reported. She presented with pathological laughter as her principal symptom which was cured by tumour resection. A brief review of the available literature on the subject is reported.
OBJECTIVE AND IMPORTANCE: This is a report of four cases of huge trigeminal neuromas that presented with the principle symptom of pathological laughter (PL). CLINICAL PRESENTATION: All four patients were male and were in either the third or fourth decade of life. In addition to PL, there were neurological deficits related to trigeminal nerve, brainstem, and cerebellar dysfunctions. INTERVENTION: All tumors were radically excised via a lateral basal temporal approach. The PL was cured immediately after surgery. CONCLUSION: PL sometimes precedes other neurological manifestations and may be a useful localizing sign. The clinical and radiological features in our cases suggest that PL is a result of extra-axial compression of the pons and adjoining neural structures.
We tested whether listeners are differentially responsive to the presence or absence of voicing, a salient, distinguishing acoustic feature, in laughter. Each of 128 participants rated 50 voiced and 20 unvoiced laughs twice according to one of five different rating strategies. Results were highly consistent regardless of whether participants rated their own emotional responses, likely responses of other people, or one of three perceived attributes concerning the laughers, thus indicating that participants were experiencing similarly differentiated affective responses in all these cases. Specifically, voiced, songlike laughs were significantly more likely to elicit positive responses than were variants such as unvoiced grunts, pants, and snortlike sounds. Participants were also highly consistent in their relative dislike of these other sounds, especially those produced by females. Based on these results, we argue that laughers use the acoustic features of their vocalizations to shape listener affect.
PURPOSE: Seizures with ictal laughter (also termed gelastic seizures) have been associated with hypothalamic hamartomas and precocious puberty. It is not known, however, where in the brain such seizures originate. We describe a child with gelastic seizures and a hypothalamic lesion (probably a hamartoma) in whom two dysfunctional phenomena were observed. RESULTS: First, there was a hyperperfusion in the hypothalamopituitary areas shown by ictal [99m]Tc hexamethyl-propyleneamine oxime (HM-PAO) single photon-emission computed tomography (SPECT). Second, there was an ictal pulse of gonadotropins, 17 beta-estradiol, and growth hormone well above the normal limits in one of the seizures. CONCLUSION: These findings suggest that gelastic seizures associated with hypothalamic hamartomas are generated in the hypothalamus or in its neighboring regions and that these seizures may cause paroxysmal dysfunction of the hypothalamopituitary axis.
A case of sustained involuntary laughter is described, with accompanying alteration of mood, due to infarction of the inferior and lateral aspects of the left temporal lobe. The lesion was localized by the clinical findings, by electroencephalography, by a radioisotope brain scan, and by angiography. The problem of the neurology of emotional behaviour is discussed in the context of the localization of the lesion in this case.
Seizures with laughter, verbalization, and repetitive abduction-adduction movements of the upper limbs are described in a 13 year old male of normal intelligence. Cinéfilm and EEG records illustrate some of the points made in the text.
Pathological laughing and crying (PLC) is increasingly recognized to accompany diverse neurologic conditions, although it remains poorly understood. The authors describe 3 cases of amyotrophic lateral sclerosis (ALS) with an unusual change from a predominance of pathological crying to laughter following drug treatment. Possible explanations for this phenomenon are discussed.
The purpose of this research was to uncover a structural definition of laughing in persons over 65. The structural definition that arises from this study is: laughing is a buoyant immersion in the presence of unanticipated glimpsings prompting harmonious integrity which surfaces anew through contemplative visioning. This definition is congruent with some of the current literature and practices related to laughter and health. It corresponds to the principles of Parse's human becoming theory and thus expands understanding of human experiences related to structuring meaning, living in relation to others, and viewing the familiar in a new light.
We present a 47-year-old woman with a long history of anxiety and a more recent history of shock-like facial pain and episodes of laughter without any motivation. She could not explain the laughing bursts and did not have a sense of mirth preceding it. On neurological examination she presented a VI nerve palsy and trigeminal hypoesthesia (V2 and V3) on the right side. Magnetic resonance imaging exhibited a large cystic lesion on the right middle fossa causing significant compression on the brain stem. A frontoorbitozygomatic and pretemporal combined approach was performed. During intra and extradural exploration a large tumor was found on the trigeminal nerve. The whole lesion was resected, revealing to be a neurinoma on pathological exhamination. She maintained a VI nerve palsy but had complete remission of the unmotivated laughing episodes during the one year follow up.
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH) founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The diagnosis of cancer is incredibly stressful, and treatments are arduous. Humor may help to ease the pain, show the human side of the health care team, and help everyone cope. Whether the patient uses humor to lighten the mood of a difficult consultation with their physician, or health care workers use it to help cheer each other through the day, humor and laughter can be valuable tools. Humor can soften the isolation experienced by both patients and staff. When used sensitively, respecting the gravity of the situation, humor can build the connection among the caregiver, patient, and family. However, insensitive joking is offensive and distressing, and experience suggests a variable acceptance of humor by patients with life-threatening illnesses, making humor a high-risk strategy, and it can be a pejorative maker of an adversive power differential. The medical literature contains little on humor, and very little research has been conducted on this common aspect of human communication. Through an examination of physician and nurse experiences, the role of humor in medicine is reviewed.
This study investigated the frequency of public laughter in a total of 10,419 children, adolescents, young adults, middle-aged adults, and older adults. Females laughed significantly more than males, and younger people generally laughed more than older people.