![]() ![]() 57 Anger proneness may also be considered a form of impaired affective modulation post stroke. Estimates of the prevalence of PLC range from 6% to 34% in the acute to subacute poststroke period. The prevalence of the disorders of involuntary emotional expression is not entirely clear due to heterogeneity in definitions. If episodes are not stereotyped and are always preceded by an affectively congruent stimulus, emotional lability is a more appropriate term. 56 Also, these episodes need not be accompanied by a congruent emotional feeling (i.e., an episode of crying may be preceded by a humorous joke). Pathological laughing and crying (PLC) is characterized by sudden, stereotyped (i.e., of similar intensity or duration) displays of emotion that do not need to be triggered by a stimulus of appropriate valence. Jorge MD, in Stroke Rehabilitation, 2019 Pathological Laughing and Crying If you feel tears coming on can you control yourself to stop them?ĥ.Melissa Jones MD, Ricardo E. Does the weepiness come suddenly at times when you were not expecting it?Ĥ. Have you actually cried more in the last 2 weeks?ģ. Have you been more tearful in the last 2 weeks than you were before your stroke?Ģ. (1999) proposed the assessment of severity of pathological emotions be based on the House criteria including the following questions scored "1" for yes and "0" for no:ġ. Assessment of the severity of pathological crying and laughing was first accomplished by developing the pathological laughing and crying scale (PLACS) (Robinson et al. Kim and Choi-Kwon (2000) suggested that both the patient and relatives must agree that pathological laughter or crying occurred on at least two occasions and that the laughter or crying was either excessive or inappropriate to the situation in which it occurred. (1989) suggested that the diagnosis be based on an increased tearfulness with episodes of crying or laughing that were sudden or unheralded and not at all under normal social control. These criteria describe classic pseudobulbar affect and do not describe the majority of cases with pathological emotion. No voluntary control of facial expression. Absence of a corresponding change in mood during or lasting beyond the actual laughing and crying.Ĥ. Lack of relationship between affective change and the observed expression.ģ. Response triggered by non-specific stimuli.Ģ. Poeck (1985) proposed that a diagnosis of pathological laughing and crying should be based on the existence of four characteristics:ġ. ![]() This condition has also been associated with a variety of neurological disorders including stroke, multiple sclerosis, traumatic brain injury, amyotrophic lateral sclerosis, central pontine, myelinolysis and anoxia (Langworth and Hesser 1940). This phenomenon has been referred to by a variety of names including pathological emotions, emotional lability, emotional incontinence, and emotionalism as well as pseudobulbar affect (Lawson and Macleod 1969 Wolf et al. Fears of developing uncontrollable emotional display can lead to social phobia and withdrawal. These uncontrolled outbursts of pseudoemotion are almost uniformly embarrassing to patients. The clinical manifestations of pathological emotions may range from facial expressions of happiness or sadness to loud and uncontrolled outbursts of laughing or weeping. Pathological laughing and crying is a phenomenon characterized by outbursts of emotion which are out of proportion to the underlying feelings of happiness and sadness (Wilson 1923). Therefore, most clinicians abandoned the term, pseudobulbar affect, in favor of the more general term, pathological laughing and crying (Davison and Kelman 1939). Most cases of uncontrollable crying and laughing, however, were not associated with bilateral upper motor neuron or supra tentorial motor pathway lesions. Patients would present with an incongruity between the loss of voluntary facial movement and the unimpaired reflexive facial movements associated with spontaneous laughing or crying. A frequent accompaniment of pseudobulbar palsy was uncontrollable crying or laughing which was referred to as pseudobulbar affect. In 1877, Lepine described pseudobulbar palsy as a cranial nerve palsy (i.e., inability to swallow, move the tongue, articulate, forcefully close the eyes) induced by supranuclear lesions (i.e., lesions of the corticobulbar or corticopontine pathway) resulting from bilateral strokes. The association of brain injury with uncontrollable episodes of crying, or less frequently laughing, has been recognized as a consequence of brain injury since the 19th century (Wilson 1923 Davison and Kelman 1939).
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