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Pathological laughter and crying: A case series and proposal for a new classification.

Francisco de Assis Aquino Gondim1, Florian P Thomas, Salvador Cruz-Flores

  • 1Department of Neurology,Saint Louis University School of Medicine, St. Louis, MO, USA, Departamento de Clínica Médica, Universidade Federal do Ceará,Fortaleza, Brazil

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A new classification for disorders of laughter and crying (DLC) categorizes them by intensity, frequency, and lesion type. This framework aids understanding across various neuropsychiatric conditions.

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Area of Science:

  • Neuroscience
  • Neurology
  • Psychiatry

Background:

  • Disorders of laughter and crying (DLC) are observed in various neuropsychiatric conditions.
  • Current nomenclature for DLC is debated and lacks a unified framework.

Purpose of the Study:

  • To introduce a novel classification system for disorders of laughter and crying.
  • To categorize DLC based on phenomenology and pathogenesis.

Main Methods:

  • Clinical and imaging data from 17 patients with DLC were analyzed.
  • Patients were classified into hypoactive or hyperactive DLC based on laughter/crying intensity and frequency.
  • Subtypes included sensory (positive/negative), motor (positive/negative), and mixed, linked to "feeling" or "emotion" processing and lesion type.

Main Results:

  • DLC etiologies included ischemic stroke, hemorrhage, gunshot wound, ALS, and vestibular migraine.
  • Lesions were located in the brainstem, cerebral hemispheres, and sub-cortical-diencephalic structures.
  • Specific subtypes identified were negative motor DLC, positive sensory DLC, negative sensory DLC, and positive motor DLC, with some progressing to mixed DLC.

Conclusions:

  • A new phenomenological and pathomechanistic nomenclature for DLC has been proposed.
  • This classification system encompasses all DLC subtypes across neurologic, medical, and psychiatric conditions.
  • Prospective validation of this novel nomenclature is recommended.