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

Authors

  • Andrea E. Cavanna MD, PhD,

    Corresponding author
    1. Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, United Kingdom
    2. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, United Kingdom
    3. Department of Mental Health Sciences, UCL, London, United Kingdom
    • Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Barberry Building, Birmingham B152FG, United Kingdom
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  • Fizzah Ali MBCHb,

    1. Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, United Kingdom
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  • James F. Leckman MD,

    1. Department of Pediatrics, Child Study Center, Yale University, New Haven, Connecticut, USA
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  • Mary M. Robertson MBChB, MD, DsC(Med), FRCP(UK), FRCPCH, FRCPsych

    1. Department of Mental Health Sciences, UCL, London, United Kingdom
    2. Department of Neurology, St George's Hospital and Medical School, London, United Kingdom
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  • Potential conflict of interest: AEC and MMR are supported by a grant from the Tourettes Action-UK. All other authors have nothing to disclose.

Abstract

Patients with Gilles de la Tourette syndrome (GTS) can display socially inappropriate behaviors as part of their multiform tic phenomenology. Pathological laughter (PL), defined as the presence of episodic and contextually inappropriate outbursts of laughter, has been detailed as a symptom of various psychiatric and neurological conditions. We present a case series of eight subjects diagnosed with GTS who reported PL as part of their tic repertoire. All subjects experienced PL as a simple phonic tic, accompanied by characteristic premonitory urges and significant impairment in social interactions. In addition, all patients presented with multiple tic-related symptoms (mainly self-injurious behaviors and echolalia, n = 7; palilalia, n = 6; coprolalia/mental coprolalia, n = 5), and six patients had comorbid conditions (in particular obsessive-compulsive disorder/behaviors, n = 7; attention-deficit hyperactivity disorder, n = 4). We suggest that the pathophysiological mechanisms underlying the expression of PL as a tic could involve a dissociation between frontostriatal and limbic networks. © 2010 Movement Disorder Society.

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