Chen Yu-Ren, Huang Ya-Ping, Lin Shan-Ju, Kuan Tsao-Hsiang, Lin Chin-Hsien
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
Clin Neuropharmacol. 2010 Nov-Dec;33(6):319-22. doi: 10.1097/WNF.0b013e3181f6bfbe.
Pathological laughing (PL) is an uncommon distressing symptom that occurs in patients with various neurological disorders. Dysregulation of serotonergic system has been proposed as one of the possible mechanisms resulting in this condition, and selective serotonin reuptake inhibitors have been used for treatment of PL with variable effects. However, the pathogenetic mechanism of PL remains largely elusive, and other treatment choices needs to be explored. This case report illustrates the beneficial effect of quetiapine, an atypical antipsychotic agent with enhancing serotonergic neurotransmitter activity, in a patient with post-stroke PL. In addition, previously reported post-stroke PL cases searched from PubMed (1993-2010) were also reviewed. In this report, we demonstrate a 42-year-old man who developed PL 4 weeks after a hemorrhage stroke affecting the paramedian pons. He was treated with dextromethorphan initially but did not show obvious response. Then, the medication was shifted to quetiapine at a dosage of 25 mg/d. There was a significant and rapid recovery 2 days after quetiapine treatment. Our observations expand the current knowledge of treatment of PL caused by pontine lesions. Further large-scale controlled trials are warranted to evaluate the beneficial and differential effects of quetiapine on PL.
病理性发笑（PL）是一种出现在各种神经系统疾病患者身上的罕见且令人苦恼的症状。血清素能系统失调被认为是导致这种情况的可能机制之一，选择性血清素再摄取抑制剂已被用于治疗PL，但效果不一。然而，PL的发病机制在很大程度上仍然不清楚，需要探索其他治疗选择。本病例报告说明了喹硫平（一种具有增强血清素能神经递质活性的非典型抗精神病药物）对一名中风后PL患者的有益作用。此外，还对从PubMed（1993 - 2010年）检索到的先前报道的中风后PL病例进行了回顾。在本报告中，我们展示了一名42岁男性，他在影响脑桥旁正中的出血性中风4周后出现PL。他最初接受右美沙芬治疗，但未显示出明显反应。然后，药物换成了喹硫平，剂量为25毫克/天。喹硫平治疗2天后有显著且快速的恢复。我们的观察扩展了目前对脑桥病变所致PL治疗的认识。有必要进行进一步的大规模对照试验，以评估喹硫平对PL的有益和差异效应。
