Pathological laughter in Gilles de la Tourette syndrome: An unusual phonic tic

Cavanna, Andrea E.; Ali, Fizzah; Leckman, James F.; Robertson, Mary M.

doi:10.1002/mds.23216

Cited by 22 publications

(7 citation statements)

References 52 publications

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“…Laughter and crying behaviors that occur detached from emotional content were reported in patients with TS as part of tic behaviors 160 and other neurodevelopmental disorders (eg, Angelman syndrome, 161 partial trisomy 16p, 15 and Rett-like syndromes 162 ). However, pathological laughter and crying is most commonly associated with neurodegenerative disorders, such as ALS, 163 FTD, 164 Alzheimer's disease, 165 primary progressive aphasia, 166 multiple system atrophy cerebellar type, 167 CJD, 168 spinocerebellar ataxia (SCA) 17, 169 and HD.…”

Section: Pathological Laughter and Cryingmentioning

confidence: 99%

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The spectrum of involuntary vocalizations in humans: A video atlas

et al. 2019

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In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video‐documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic‐like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep‐related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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Section: Pathological Laughter and Cryingmentioning

confidence: 99%

“…For example, fluoxetine was used to control laughing tics in TS. 160 However, the efficacy of these treatments remains understudied. An important caveat is the treatment of tic-like behaviors in functional neurological disorders in which behavioral therapies should be preferred over pharmacological agents.…”

Section: Treatment Optionsmentioning

confidence: 99%

The spectrum of involuntary vocalizations in humans: A video atlas

et al. 2019

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“…Some of the more interesting complex tics have significant social relevance. These include coprolalia: swearing tics; echo-phenomena: the urge to imitate other people's speech and behavior; and non-obscene socially inappropriate symptoms (NOSIS): urges to perform behaviors which will cause social disruption or offence to others (Cavanna et al, 2010;Kurlan et al, 1996;Eddy & Cavanna, 2013a&b).…”

Section: Introductionmentioning

confidence: 99%

Triangles, tricks and tics: Hyper-mentalizing in response to animated shapes in Tourette syndrome

Eddy

Cavanna

2015

Cortex

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Tourette syndrome (TS) can feature complex tics involving socially inappropriate behaviours. Adults with TS can also demonstrate differences to healthy controls when reasoning about mental states. This study investigated spontaneous mentalizing in TS. Twenty adults with TS and twenty healthy controls completed the animations task. Participants were asked to watch short ambiguous animations involving two triangles and describe what was happening. Some animations featured random movement of the triangles, while others depicted social interactions that were simple (e.g., dancing) or more complex (e.g., one triangle tricking the other). Measures were taken of executive functions, alexithymia and clinical symptoms. Individuals with TS responded similarly to controls when viewing animations featuring simple and complex interactions, demonstrating intact mentalizing ability. However, significant group differences were apparent for the random movement animations. TS was associated with a greater tendency to attribute mental states during this condition, and to describe random movements as motivated actions guided by the intentions of the triangles. There were no group differences for the alexithymia scale, but TS was associated with mild executive deficits. No relationships were apparent between animation responses and other measures. Our findings suggest that TS is associated with a propensity to adopt the intentional stance. Hyper-mentalizing in TS could be linked to both dopamine dysfunction and altered social behaviour, whereby amplified salience of social cues could contribute to the complex interplay between environmental context and tic expression. These observations may offer further insight into the potential effects of dopamine dysfunction on social cognition.

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“…Cavanna A.E. et al (2010) [ 46 ] described 8 patients with Gilles de la Tourette syndrome presenting PLC as part of their tic repertoire. All patients experienced PLC as a simple phonic tic, accompanied by characteristic premonitory urges and significant impairment in social interactions.…”

Section: Discussionmentioning

confidence: 99%

Pathological laughter as prodromal manifestation of transient ischemic attacks—case report and brief review

et al. 2015

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BackgroundBased on a case report, the authors reviewed the data about involuntary emotional expression disorder (IEED). IEED includes the syndromes of pathological laughing and crying (PLC) and emotional lability (EL). PLC is a rare disorder of emotional expression characterized by relatively uncontrollable episodes of laughter and crying or both that do not have an apparent motivating stimulus.Case presentationAuthors report the case of a 59-year-old man who presented with recurrent episodes of PLC of approximately 2 min duration, consisting of accelerated breathing, emission of guttural, snoring sounds, frowning of the eyebrows, followed by laughter accompanied by motor restlessness of all four limbs. PLC episodes preceded left carotid transient ischemic attacks (TIA’s) manifested by reversible aphasia and right hemiparesis. Electroencephalography performed during PLC episodes revealed no spike-wave activity. Brain magnetic resonance imaging showed lacunar infarcts in the left lenticulo-capsulo-thalamic area and multiple round lesions in the cortical-subcortical and in the deep white matter of frontal-parietal-occipital lobes bilaterally, with T2 hyperintensity, T1 isointensity and no diffusion changes. The episodes were interpreted as transient ischemic attacks although gelastic seizures could not be excluded. The etiological investigations revealed unstable plaques on the left carotid artery bulb and the aortic arch and a degenerative mitral valve stenosis. The patient was treated first with antiplatelet therapy and antiepileptic drugs but PLC stopped only after anticoagulation was started. During follow-up the patient continued to have left carotid and vertebrobasilar TIA’s being on oral anticoagulation. The patient became asymptomatic only after mitral valve replacement was performed.ConclusionsThis case illustrates the difficulty distinguishing between gelastic epilepsy and TIA’s in cases of PLC episodes and discuss the neuroanatomic bases and pathophysiology of this rare condition.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0457-3) contains supplementary material, which is available to authorized users.

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Pathological laughter in Gilles de la Tourette syndrome: An unusual phonic tic

Cited by 22 publications

References 52 publications

The spectrum of involuntary vocalizations in humans: A video atlas

The spectrum of involuntary vocalizations in humans: A video atlas

Triangles, tricks and tics: Hyper-mentalizing in response to animated shapes in Tourette syndrome

Pathological laughter as prodromal manifestation of transient ischemic attacks—case report and brief review

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