Shin Sang Hoon, Kim Yong Wook, Kim Na Young
Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Clin Neuropharmacol. 2019 Mar/Apr;42(2):60-63. doi: 10.1097/WNF.0000000000000319.
Pathologic laughing is characterized by episodes of uncontrollable laughter caused by underlying neurologic disturbances, such as stroke. Several types of medication, including selective serotonin reuptake inhibitors, have demonstrated only limited success at treating the condition. Duloxetine, a dual serotonin-norepinephrine reuptake inhibitor, is reportedly effective in treating the symptoms of mood disorders. We herein introduce a prospective consecutive sample of stroke patients with pathologic laughing treated with duloxetine.
We enrolled patients without a history of psychological illness who exhibited poststroke pathologic laughter. Duloxetine administration was commenced at an initial dose of 30 mg once daily. The dose was increased to 60 mg once daily within 2 weeks for all patients except 2. The effect of the treatment was assessed by means of the Pathological Laughter and Crying Scale.
A total of 7 patients were included in the study. Improvements were observed within an average of 10 days after duloxetine administration. Pathological Laughter and Crying Scale score decreased after duloxetine administration in all patients, and 4 patients demonstrated a decrease in score of more than 50%. All patients reported subjective improvement of symptoms, and no adverse effects were observed.
This case series demonstrates that duloxetine could attenuate pathologic laughing exhibited by stroke patients; however, further randomized controlled studies are necessary to validate our findings.
病理性发笑的特征是由潜在的神经功能障碍（如中风）引起的无法控制的发笑发作。包括选择性5-羟色胺再摄取抑制剂在内的几种药物在治疗这种病症方面仅取得了有限的成功。度洛西汀是一种5-羟色胺-去甲肾上腺素双重再摄取抑制剂，据报道对治疗情绪障碍症状有效。我们在此介绍一组接受度洛西汀治疗的中风后病理性发笑患者的前瞻性连续样本。
我们纳入了没有心理疾病史且出现中风后病理性发笑的患者。度洛西汀的初始剂量为每日一次30毫克。除2名患者外，所有患者在2周内将剂量增加至每日一次60毫克。通过病理性哭笑量表评估治疗效果。
共有7名患者纳入研究。度洛西汀给药后平均10天内观察到病情改善。所有患者度洛西汀给药后病理性哭笑量表评分均下降，4名患者评分下降超过50%。所有患者均报告症状有主观改善，且未观察到不良反应。
该病例系列表明度洛西汀可减轻中风患者表现出的病理性发笑；然而，需要进一步的随机对照研究来验证我们的发现。
