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Pathological laughter and crying in neurological disorders: recognition and treatment
  1. Emma Husbands1,
  2. Kevin Talbot2
  1. 1 Palliative Medicine, GHNHSFT, Gloucester, UK
  2. 2 Clinical Neurosciences, Oxford University, Oxford, UK
  1. Correspondence to Dr Emma Husbands, Palliative Medicine, GHNHSFT, Gloucester, UK; emma.husbands{at}


Pathological laughter and crying is a disabling symptom complex associated with damage to various central nervous system pathways that control the reflex motor component of emotional expression. Many underlying conditions—including neurodegenerative diseases, CNS inflammation, vascular lesions and traumatic brain injury—can be associated with disinhibition of emotional reflex control. This suggests a disruption of anatomical and functional networks, rather than any specific unifying pathological process. There is a wide differential diagnosis, including depression, dementia and other forms of behavioural disturbance. Diagnostic criteria and rating scales can help with clinical assessments and facilitate clinical trials. There is now good-quality evidence for a combination of dextromethorphan and quinidine, with weaker evidence for tricyclic and selective serotonin reuptake inhibitor antidepressants. Pathological laughter and crying is disabling and underdiagnosed but potentially treatable, and its wider recognition is important.

  • ALS
  • Motor neuron disease
  • Multiple sclerosis
  • Parkinson-s disease
  • Quality of life

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  • Contributors Equal contribution by both authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed by Chris McDermott, Sheffield, UK.

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