title: Pseudobulbar laughter as a levodopa off phenomenon exacerbated by subthalamic deep brain stimulation.
abstract: Pseudobulbar affect is a common symptom in neurodegenerative diseases and can also result from lesions in cortical, subcortical and brainstem regions. In Parkinson's disease (PD), pseudobulbar affect (PBA) can occur as a wearing off phenomenon, manifested usually as crying without emotionality. In addition, subthalamic (STN) deep brain stimulation (DBS) has been reported to induce PBA in PD patients with no prior history of such episodes. We present a case of inappropriate laughter lacking mirth as a levodopa OFF phenomenon in a patient with PD, whose laughter also worsened with STN-DBS in his non-medicated state. Levodopa ameliorated his PBA both with and without stimulation. The case demonstrates pseudobulbar laughter as a levodopa OFF phenomenon that is also exacerbated by STN-DBS.
authors.affiliation: Medical University of Lublin, Lublin, Poland.
authors.forename: P K
authors.initials: PK
authors.lastname: Chattha
authors.affiliation: Department of Neurology Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Greene
authors.affiliation: Department of Neurology Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA ; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 5 East 98th St. First Floor, New York, NY 10029 USA.
authors.forename: Ritesh A
authors.initials: RA
authors.lastname: Ramdhani
keywords: Deep brain stimulation; Off phenomenon; Pseudobulbar affect