![]() ![]() Often months after a patient is coming to terms with their serious diagnosis, intense pathological crying continues and can make it difficult to interact with family or uncomfortable going out in public. However, every once in a while, I will meet someone who has pathological laughing and they find it odd, given they are having intense episodes of laughing after being given a serious neurodegenerative diagnosis. Given ALS is a terminal illness, it is an emotional time for most patients, and crying is appropriate. When I see patients in ALS clinic, I often use a basic screening question, “Do you have any episodes or laughing or crying that are now more difficult to control?” I get varied answers. One of my first studies, which was published in Brain 2011, showed in patients with ALS that these episodes of pathological laughing and crying were linked to specific triggers and the first episodes were triggered by strong emotions consistent with the emotions being displayed. The actual mechanism is poorly understood, but there is currently FDA approved medication if the symptoms of pseudobulbar affect are recognized. PBA is most common in the setting of amyotrophic lateral sclerosis (ALS). Pathological laughing and crying is often a change from a patient’s baseline control of emotion and occurs in the setting of neurologic disease, which suggests that it is not psychological. It occurs in the setting of numerous neurologic diseases, including amyotrophic lateral sclerosis (ALS), progressive supranuclear palsy, multiple sclerosis (MS), stroke, traumatic brain injury (TBI) and other neurologic disorders. Pathological laughing and crying, otherwise known as pseudobulbar affect (PBA), is when intense laughter or intense crying is easily triggered and difficult to control. This fits within the spectrum of normal emotion and is not considered pathological laughing and crying. The majority of people without neurologic disease can recall a time that they had intense laughter or intense crying that was next to impossible to control. Note: Group with CNS-LS ≥21 is a subset of the group with CNS-LS ≥13.Pathological laughing and crying is a disorder of emotional expression that occurs in the setting of neurologic disease. CNS-LS, Center for Neurologic Study–Lability Scale TCA, tricyclic antidepressant(s). ![]() * P<0.0001 compared with CNS-LS <13 chi-square test. Psychotropic medication use by CNS-LS threshold. Note: Group with CNS-LS ≥21 is a subset of the group with CNS-LS ≥13. CNS-LS, Center for Neurologic Study–Lability Scale. * P<0.0001 compared with CNS-LS <13 two-sample t-test. Impact of neurological condition on quality of life by CNS-LS threshold. #Pathological laughter and crying series#PBA symptom prevalence by CNS-LS threshold.ĪD, Alzheimer’s disease ALS, amyotrophic lateral sclerosis CNS-LS, Center for Neurologic Study–Lability Scale MS, multiple sclerosis PBA, pseudobulbar affect PD, Parkinson’s disease PRISM, PBA Registry Series TBI, traumatic brain injury. Sample interim PRISM registry report available to activated sites.ĬNS-LS, Center for Neurologic Study–Lability Scale PRISM, PBA Registry Series. aPatient interview bCNS-LS ≥13 (higher estimate), CNS-LS ≥21, lower estimate c Poeck criteria: pathological affect could be mood congruent (emotional lability) or incongruent (pathological laughing and crying) dRetrospective review of hospital or clinic records eMailed questionnaire fEmotional lability questionnaire (ELQ) gAscertainment method unknown hPatient interview, Poeck criteria iBrief questionnaire (uncontrollable laughing/crying when not happy/sad) jCNS-LS ≥13 (highest estimate), CNS-LS ≥17 (middle estimate), Cummings Involuntary Emotional Expression Disorder criteria (lowest estimate) kCNS-LS ≥17 (lower estimate), CNS-LS ≥13 (higher estimate) lPathological Laughing and Crying Scale (PLACS) ≥10 and score of ≥2 on PLACS items 2 (frequency), 13 (loss of voluntary control), and 18 (distress/embarrassment) mPatient interview House (lower estimate), and Kim (higher estimate) criteria nPatient interview House criteria oPatient interview Kim criteria pPatient interview Kim criteria (lower estimate n = 516) and modified Kim criteria (patient report only without corroboration from relatives higher estimate) qPatient interview Kim criteria at hospital admission (lower estimate) and at 3 months (higher estimate) following stroke. ![]() AD, Alzheimer’s disease ALS, amyotrophic lateral sclerosis CNS-LS, Center for Neurologic Study–Lability Scale MS, multiple sclerosis PBA, pseudobulbar affect PD, Parkinson’s disease PRISM, PBA Registry Series TBI, traumatic brain injury. Published PBA symptom prevalence estimates by primary neurological condition. ![]()
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