Histo

Clinical and Research Reports | |Neuroanatomy of Pathological Laughing and Crying: A Report of the American Neuropsychiatric Association Committee on Research
Josef Parvizi, M.D., Ph.D., Kerry L. Coburn, Ph.D., Samuel D. Shillcutt, Ph.D., C. Edward Coffey, M.D., Edward C. Lauterbach, M.D. and Mario F. Mendez, M.D. Ph.D.
ABSTRACT
Pathological laughing and crying (PLC) is a clinical condition that occurs in patients with various neurological disorders. It is characterized by the presence of episodic and contextually inappropriate or merely exaggerated outbursts of laughter and/or crying without commensurate feelings. This review provides an in depth analysis of the neuroanatomy of lesions seen in patients with this clinical condition, discusses the relevant functional neuroimaging and electrophysiological stimulation studies in human subjects, and summarizes the current treatment options. It concludes with a presentation of the remaining questions and directions for future research.
The Clinical Phenotype
Emotional experience is the subjective feeling during an emotional event whereas emotional expression is the objective behavior that is expressed during such event, including changes in autonomic functions such as heart rate1,2 and skeletal movements such as facial expression. Both the experience and the expression of an emotion are dependent in part upon the cognitive appraisal of the emotional stimuli which are triggering it, as reviewed extensively by others.2 While many psychiatric conditions lead to a problem with emotional experience (e.g., mood disorders), many patients with neurological disorders suffer from problems with dysregulation of emotional expression. In these patients the problem involves mostly the expressions of laughter or crying. While some patients exhibit problems with only laughter, others have problems with only crying, and some exhibit problems with both. Although these patients do not laugh or cry at all times, when they do, the