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Pathological laughter and crying: insights from lesion network-symptom-mapping.

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Summary

Pathological laughter and crying (PLC) is linked to a specific brain network, involving both direct lesions and indirect effects. This network helps explain the neural basis of emotional and volitional control over vocalizations.

Keywords:
diaschisispseudobulbar affectresting-state functional connectivity

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Area of Science:

  • Neuroscience
  • Neurology

Background:

  • Pathological laughter and crying (PLC) involves uncontrollable emotional outbursts secondary to central nervous system (CNS) disorders.
  • Previous models proposed a diffuse cortico-limbic-subcortico-thalamo-ponto-cerebellar network for PLC.

Observation:

  • Using lesion network-symptom-mapping on 70 focal lesions from PLC case reports, a common bilateral network specific to PLC was identified.
  • This network shows positive connectivity with emotional processing regions (cingulate, temporomesial cortices, striatum, hypothalamus, mesencephalon, pons) and negative connectivity with motor/sensory cortices.

Findings:

  • The identified PLC network comprises distinct subnetworks: a 'positive PLC subnetwork' linked to emotional facial paresis and a 'negative PLC subnetwork' overlapping with the volitional facial movement system.
  • Lesions causing emotional facial paresis mapped to the positive subnetwork, while those causing volitional facial paresis mapped to the negative subnetwork.

Implications:

  • A two-hit model for PLC is proposed, involving direct lesion effects and indirect diaschisis, leading to loss of cortical inhibition over a dysfunctional emotional system.
  • This network-based approach refines our understanding of the neural underpinnings of emotional expression and control.