Pathologic laughing and intractable hiccups can occur early in multiple sclerosis

Area of Science:

• Neurology
• Neuroscience
• Medical Imaging

Background:

• Pathologic laughing affects about 10% of multiple sclerosis (MS) patients, typically in the chronic stage.
• Intractable hiccups are also a recognized, though less common, symptom in MS.
• The specific neuroanatomical correlates for these symptoms, particularly in early MS, remain under investigation.

Observation:

• This study details four cases of multiple sclerosis patients presenting with pathologic laughing at an early disease stage.
• In two of these patients, the pathologic laughing was accompanied by intractable hiccups.
• Magnetic Resonance Imaging (MRI) revealed enhanced lesions in the medulla oblongata and mesencephalon in two patients.

Findings:

• Early-stage multiple sclerosis can manifest with pathologic laughing and intractable hiccups.
• Lesions in the medulla oblongata and mesencephalon are implicated in the pathophysiology of these symptoms.
• The presence of enhanced lesions suggests active inflammation in these critical brain regions.

Implications:

• These findings suggest that early identification of brainstem lesions may aid in diagnosing and managing neurologic symptoms like pathologic laughing and hiccups in MS.
• Understanding these early indicators could lead to earlier therapeutic interventions in multiple sclerosis.
• Further research is warranted to confirm the causal link between brainstem lesions and these specific MS symptoms.