Disturbances in the Voluntary Control of Emotional Expression After Stroke

  • Jong S. Kim
  • Smi Choi-Kwon
Part of the Neuropsychiatric Symptoms of Neurological Disease book series (NSND)


Disturbances in the voluntary control of emotional expression after a stroke were first reported in the nineteenth century and extensively reviewed by Wilson in 1924. A variety of terms have since been used such as pathological laughing and crying, pseudobulbar affect, emotionalism, emotional lability, involuntary emotional expression disorder, and post-stroke emotional incontinence (PSEI). The prevalence of PSEI ranges 6–34 % (mostly 10–20 %) of stroke patients. It seems that PSEI is more often observed in the subacute stage than in the acute or chronic stage. However, there are patients who show abnormal emotional display before the onset of other major neurologic dysfunction (fou rire prodromique).

Recent advances in brain imaging technologies have shown that lesions affecting frontal-internal capsular-pontine base circuitry most often produce PSEI. Cerebellar, basal ganglionic, and thalamic lesions are also occasionally associated with PSEI. Wilson proposed that pathological crying and laughing is caused by disinhibition of a brainstem fasciorespiratory control center for emotional expression secondary to lesions of descending corticobulbar pathways from higher cortical brain centers. This disinhibition theory has been modified, and it is currently believed that deficits in any areas of brain network related to emotional expression (cortico-limbic subcortical-thalamic-ponto-cerebellar system) can lead to PSEI.

Lesion location studies, positron emission tomography studies, and clinical trial results have shown that serotonin dysfunction plays an important role in producing PSEI. Selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line agents for the treatment of PSEI as they are promptly effective and tolerable and may also improve patients’ quality of life. When SSRIs are ineffective or poorly tolerated, tricyclic antidepressants, selective adrenergic receptor inhibitors, or dopaminergic agents can be considered.


Emotion Expression Crying Laughing Depression Stroke 


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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of Ulsan College of Medicine, Asan Medical CenterSong-Pa, SeoulSouth Korea
  2. 2.College of Nursing, Research Institute of Nursing ScienceSeoul National UniversitySeoulKorea

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