title: Therapeutic Approach of a High Functioning Individual With Traumatic Brain Injury and Subsequent Emotional Volatility With Features of Pathological Laughter and Crying With Dextromethorphan/Quinidine.
abstract: Pathological laughing and crying, or pseudobulbar affect (PBA), has been described in patients with neurological disorders such as multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's disease, stroke, and traumatic brain injury (TBI) since the 19th century (Schiffer 2005). The syndrome is characterized by inappropriate episodes of laughing or crying after minor stimuli. It was first coined a disinhibition of cortical control by Kinnier Wilson in 1924. It was observed in brain disease and seen with mild TBI. It can impair social and occupational function and is largely underrecognized in clinical settings. PBA is usually treated with antidepressants and dopaminergic agents. In this case we treated a military recruit with TBI with Nuedexta-a dextromethorphan/Quinidine derivative with a subsequent decrease in his episodes.
authors.affiliation: From the Regimental Aid Station, NHCL (DG-B); Department of Neurology, NHCL Intrepid Spine Concussion Recovery Center (TMJ, JW); and Speech-language Pathologist (JS, MG).
authors.forename: Dynela
authors.initials: D
authors.lastname: Garcia-Baran
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Johnson
authors.forename: Joyce
authors.initials: J
authors.lastname: Wagner
authors.forename: Joann
authors.initials: J
authors.lastname: Shen
authors.forename: Michelle
authors.initials: M
authors.lastname: Geers
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000188:drug therapy* / Q000523:psychology*; D001924:Brain Concussion / Q000188:drug therapy / Q000523:psychology; D001930:Brain Injuries / Q000188:drug therapy* / Q000523:psychology*; D003448:Crying; D003915:Dextromethorphan / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D006801:Humans; D007845:Laughter; D008297:Male; D011802:Quinidine / Q000627:therapeutic use*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000523:psychology
chemical_list: D004338:Drug Combinations; C507057:dextromethorphan - quinidine combination; D003915:Dextromethorphan; D011802:Quinidine