Husbands Emma, Talbot Kevin
Palliative Medicine, GHNHSFT, Gloucester, UK
Clinical Neurosciences, Oxford University, Oxford, UK.
Pract Neurol. 2022 Dec;22(6):486-490. doi: 10.1136/pn-2021-003301. Epub 2022 Jul 30.
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.
病理性哭笑是一种致残性症状复合体，与控制情绪表达反射运动成分的各种中枢神经系统通路受损有关。许多潜在病症，包括神经退行性疾病、中枢神经系统炎症、血管病变和创伤性脑损伤，都可能与情绪反射控制的去抑制有关。这表明解剖学和功能网络遭到破坏，而非任何特定的统一病理过程。鉴别诊断范围广泛，包括抑郁症、痴呆症和其他形式的行为障碍。诊断标准和评定量表有助于临床评估并推动临床试验。目前有充分的高质量证据支持右美沙芬和奎尼丁联合使用，而三环类和选择性5-羟色胺再摄取抑制剂抗抑郁药的证据较弱。病理性哭笑具有致残性且诊断不足，但有可能得到治疗，对其更广泛的认识很重要。
