Obscure and mysterious symptom in multiple sclerosis: Pathological laughing and crying

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Pathological laughing and crying (PLC) has an approximately prevelance of 7%–10% among patients with multiple sclerosis (MS). Various damages of prefrontal, temporal cortex, internal capsule, hypothalamus, thalamus, brainstem and the cerebellar pathways may cause pathological laughing or crying. We interviewed 160 MS patients for PLC. Only 5 of our 160 cases complained about pathological laughing or crying. All 5 patients had PLC defined as sudden, involuntary displays of laughing or crying or both, without associated subjective feelings of depression or euphoria. Patient group, consisting 2 women and 3 men had a mean age of 41, mean Expanded Disability Status Scale (EDSS) score of 4.8, disease duration of 12.8 years. In our patients PLC was not associated with disease exacerbations. All PLC patients had numerous brainstem and cerebellar relapses, which caused obvious disabilities including gait ataxia, intention tremor, dysmetria, dysarthria, nystagmus and other cerebellar dysfunctions. All of our patients had so many lesions especially in brainstem because of this we think that the brainstem lesions have crucial role in PLC. This hypothesis needs further investigation especially in functional imaging which may add further information to pathogenesis of PLC. Before the investigation of PLC none of our patients informed us about their complaints of PLC so the physician must be aware of this symptom.

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pathological laughing and crying , multiple sclerosis , MRI

Cumhuriyet Medical Journal

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Cumhuriyet Medical Journal