• Foteini Christidi, Efstratios Karavasilis, Panagiotis Ferentinos, Sophia Xirou, Georgios Velonakis, Michalis Rentzos, Vasiliki Zouvelou, Ioannis Zalonis, Efstathios Efstathopoulos, Nikolaos Kelekis, and Ioannis Evdokimidis.
• a First Department of Neurology , Aeginition Hospital, Medical School, National & Kapodistrian University of Athens , Athens , Greece.
• Amyotroph Lateral Scler Frontotemporal Degener. 2018 Feb 1; 19 (1-2): 12-20.

ObjectivePathological laughing and crying (PLC) is common in several neurological and psychiatric diseases and is associated with a distributed network involving the frontal cortex, the brainstem and cortico-pontine-cerebellar circuits. By applying multimodal neuroimaging approach, we examined the neuroanatomical substrate of PLC in a sample of patients with amyotrophic lateral sclerosis (ALS).MethodsWe studied 56 non-demented ALS patients and 25 healthy controls (HC). PLC was measured in ALS using the Center of Neurologic Study Lability Scale (CNS-LS; cutoff score: 13). All participants underwent 3D-T1-weighted and 30-directional diffusion-weighted imaging at 3T. Voxel-based morphometry and tract-based spatial-statistics analysis was used to examine gray matter (GM) and white matter (WM) differences between ALS patients with and without PLC (ALS-PLC and ALS-nonPLC, respectively). Comparisons were restricted to regions with detected differences between ALS and HC, controlling for age, gender, total intracranial volume and depressive symptoms.ResultsIn regions with significant differences between ALS and HC, ALS-PLC patients showed decreased GM volume in left orbitofrontal cortex, frontal operculum, and putamen and bilateral frontal poles, compared to ALS-nonPLC. They also had decreased fractional anisotropy in left cingulum bundle and posterior corona radiata. WM abnormalities were additionally detected in WM associative and ponto-cerebellar tracts (using a more liberal threshold).ConclusionsPLC in ALS is driven by both GM and WM abnormalities which highlight the role of circuits rather than isolated centers in the emergence of this condition. ALS is suggested as a useful natural experimental model to study PLC.

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