Ictal semiology of gelastic seizures.

Gelastic seizures are rare epileptic manifestations characterized by laughter or a smile. The main etiology is represented by hypothalamic hamartoma, but also focal localization of the epileptogenic zone is described. We reviewed a group of patients with gelastic seizures to describe the semiology and to establish any difference related to diverse epilepsy etiologies. Thirty-five seizures from 16 patients (6 females) were reviewed. The study confirms that hypothalamic hamartoma is the more frequent etiology associated with gelastic seizures. Laughter represented the majority of gelastic ictal signs, while the ictal smile was less frequent. In 87.5% of patients, the manifestation of laughter or smile was the only ictal phenomenon, or the first and the most important clinical sign. Interestingly, it has been observed that patients with a lesion localized in the hypothalamic region had more frequently laughter with emotional involvement and that laughter was the only manifestation of the seizure. On the contrary, patients with lesions localized outside the hypothalamic region had more often seizures with laugh without emotional involvement, resembling a more mechanical action, and associated with other semeiological signs. It, therefore, seems possible to assume that the emotional involvement and the expression of mirth during the seizure, especially in children, are more frequently associated with hypothalamic hamartoma. On the contrary, when the semiology includes less conveyed emotion similar to a mechanical action and other symptoms, an extra hypothalamic localization should be considered.

A clinical evaluation of gelastic and dacrystic seizures: a multicenter study.

BACKGROUND: Gelastic seizures are extremely rare, short-lasting, unprovoked, and uncontrollable laughing attacks. We conducted this retrospective evaluation to determine whether these symptoms, manifesting in different forms, such as cheerful laughter, laughing, smiling, and sobbing had any value in terms of etiology or localization. METHODS: A total of 31 patients who exhibited bouts of laughing or crying and who were under follow-up between 2000 and 2019 at tertiary epilepsy centers were included in the study. Laughing seizures were divided into three groups in terms of semiology (i.e., laughter with mirth, laughter without mirth, and smile). Dacrystic seizures were accompanied by some gelastic seizures and were divided into two groups in terms of semiology (i.e., weeping loudly [motor and voice-sobbing] and crying). RESULTS: Of the 27 patients with laughing seizures, 12 had seizures that manifested with smiling, 7 had seizures that manifested with laughing and mirth, and 8 had seizures that manifested with laughter without mirth. Dacrystic-gelastic seizures were observed in four patients, among whom 2 patients had crying and laughter without mirth and 2 patients had weeping loudly and laughter without mirth episodes. CONCLUSION: Gelastic and dacrystic seizures often suggest hypothalamic hamartomas, in the literature. This rare ictal behavior can originate from different cortical locations and lesions of a different nature. However, we found that gelastic seizures with smiling were a more homogenous group with regard to location in the temporal lobe, which we aimed to show by evaluating the patients included in this study.

ANTECEDENTES: Crises gelásticas são ataques de riso extremamente raros, de curta duração, não provocados e incontroláveis. Realizamos esta avaliação retrospectiva para determinar se esses sintomas, manifestando-se de diferentes formas, como riso alegre, riso, sorriso e soluço, tinham algum valor em termos de etiologia ou localização. MéTODOS: Foram incluídos no estudo 31 pacientes que apresentavam crises de riso ou choro e que estavam em acompanhamento entre 2000 e 2019 em centros terciários de epilepsia. As crises de riso foram divididas em três grupos em termos de semiologia (ou seja, riso com alegria, riso sem alegria e sorriso). As crises dacrísticas foram acompanhadas por algumas crises gelásticas e foram divididas em dois grupos em termos de semiologia (ou seja, choro alto [motor e soluçar a voz] e choro). RESULTADOS: Dos 27 pacientes com crises de riso, 12 tiveram crises que se manifestaram com sorriso, 7 tiveram crises que se manifestaram com riso e alegria e 8 tiveram crises que se manifestaram com riso sem alegria. Crises dácristico-gelásticas foram observadas em quatro pacientes, sendo 2 pacientes com choro e riso sem alegria e 2 pacientes com choro alto e riso sem alegria. CONCLUSãO: Crises gelásticas e dacrísticas frequentemente sugerem hamartomas hipotalâmicos, na literatura. Este comportamento ictal raro pode ter origem em diferentes localizações corticais e lesões de natureza diversa. No entanto, verificamos que as crises gelásticas com sorriso foram um grupo mais homogêneo quanto à localização no lobo temporal, o que buscamos evidenciar avaliando os pacientes incluídos neste estudo.

The different shades of laughter: when do we laugh and when do we mimic other's laughter?

Laughter is an ambiguous phenomenon in response to both positive and negative events and a social signal that coordinates social interactions. We assessed (i) who laughs and why, and (ii) if the type of laughter and whether the observer approves of it impact on facial mimicry as a proxy for shared laughter. For this, 329 participants watched funny, schadenfreude and disgusting scenes and then saw individuals who purportedly reacted to each scene while participants' facial expressions were recorded and analysed. Participants laughed more in response to funny than in response to schadenfreude scenes and least in response to disgust scenes, and laughter within each scene could be explained both by situational perceptions of the scenes as well as by individual differences. Furthermore, others' laughter in response to funny scenes was perceived as more appropriate, elicited more closeness and more laughter mimicry than others' laughter in response to schadenfreude and especially in response to disgust scenes. Appropriateness and closeness as well as individual differences could explain laughter mimicry within each scene. This is in line with the notion that laughter is not per se an affiliative signal and that different types of laughter have distinct social implications. This article is part of the theme issue 'Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience'.

Laughter, play faces and mimicry in animals: evolution and social functions.

Human laughter and laugh faces show similarities in morphology and function with animal playful expressions. To better understand primordial uses and effects of human laughter and laugh faces, it is important to examine these positive expressions in animals from both homologous and analogous systems. Phylogenetic research on hominids provided empirical evidence on shared ancestry across these emotional expressions, including human laughter and laugh faces. In addition, playful expressions of animals, in general, arguably have a key role in the development of social cognitive skills, a role that may help explain their polyphyletic history. The present work examines the evolution and function of playful expressions in primates and other animals. As part of this effort, we also coded for muscle activations of six carnivore taxa with regard to their open-mouth faces of play; our findings provide evidence that these carnivore expressions are homologues of primate open-mouth faces of play. Furthermore, our work discusses how the expressions of animal play may communicate positive emotions to conspecifics and how the motor resonance of these expressions increases affiliation and bonding between the subjects, resembling in a number of ways the important social-emotional effects that laughter and laugh faces have in humans. This article is part of the theme issue 'Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience'.

Entre a Dor e a Alegria: Repercussões Subjetivas no Ser Palhaço(a) / Between Pain and Happiness: Subjective Repercussions in the Being Clown / Entre el Dolor y la Alegría: Repercusiones Subjetivas de Ser Payaso(a)

Investigou-se como a dor e a alegria podem influenciar a construção do ser palhaço(a) com o objetivo de compreender melhor a construção da sua subjetividade. Foram realizadas entrevistas com dez palhaços(as). Utilizou-se como método a análise de conteúdo e o software NVivo® para sistematizar as informações presentes nos discursos dos(as) participantes em doze categorias, agrupadas em dois eixos temáticos e analisadas a partir de sua pertinência na construção do entendimento de ser palhaço(a). Os resultados indicaram que a dor diante de perdas afetivas no processo de ser palhaço(a) passa pela transformação do trágico à comicidade, não para minimizá-la, mas para lidar com a finitude humana por meio da ética, poética e estética de afirmação da vida. A transgressão da palhaçaria permite superar dificuldades e transformá-las criativamente em riso. Conclui-se que o ser palhaço(a) torna-se a vitrine das condições humanas apresentadas por meio do cômico, do trágico, do ridículo, do perder, do político, do rústico e do ser-no-mundo.

It was investigated how pain and joy can influence the construction of being a clown in order to better understand the construction of their subjectivity. Interviews were conducted with ten clowns. Content analysis and the NVivo® software were used as a method to systematize the information present in the participants' speeches into twelve categories, grouped into two thematic axes and analyzed based on its pertinence in the construction of the understanding of being a clown. The results indicated that the pain in the face of affective losses in the process of being a clown goes through the transformation from the tragic to the comic, not to minimize it, but to deal with human finitude through ethics, poetics and life-affirming aesthetics. The transgression of clowning allows you to overcome difficulties and creatively transform them into laughter. It is concluded that being a clown becomes the showcase of human conditions presented through the comic, the tragic, the ridiculous, the losing, the political, the rustic and the being-in-the-world.

Se investigó cómo el dolor y la alegría pueden influir en la construcción del payaso, con el objetivo de comprender mejor la construcción de su subjetividad. Se realizaron entrevistas con diez payasos. El análisis de contenido y el software NVivo® se utilizaron como método para sistematizar la información presente en los discursos de los participantes, en doce categorías, agrupadas en dos ejes temáticos, y analizadas desde la pertinencia en la construcción de la comprensión del payaso. Los resultados indicaron que el dolor ante pérdidas afectivas en el proceso de ser payaso sufre una transformación de lo trágico a lo cómico, no para minimizar el dolor, sino para lidiar con la finitud humana a través de la ética, la poética y la estética afirmadora de la vida. La transgresión del clown te permite superar las dificultades y transformarlas creativamente en risa. Se concluye que ser payaso se convierte en el escaparate de las condiciones humanas que se presentan a través de lo cómico, lo trágico, lo ridículo, lo perdedor, lo político, lo rústico y el ser-en-el-mundo.

Pseudobulbar affect in neurodegenerative diseases: A systematic review and meta-analysis.

BACKGROUND: Pseudobulbar affect (PBA) is characterized by uncontrolled episodes of crying and laughing which is associated with a variety of neurological diseases including traumatic brain injury, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), brain tumors, stroke, Parkinson's disease (PD), Alzheimer's disease (AD) and other dementias. However, there is a lack of exact estimated prevalence of PBA among neurological disorders. AIM: In this systematic review and meta-analysis study we aimed to assess the prevalence of PBA in four neurodegenerative diseases including ALS, MS, AD, and PD. METHODS: PubMed, Scopus, and Web of Science were searched in July 2021 for studies that reported the prevalence of PBA in ALS, MS, AD, and PD patients. The mean point of PBA prevalence and odds ratios were calculated as effect size (ES) using the random-effect model with a 95% confidence interval (CI). RESULTS: The summarized prevalence of PBA was of PBA in PD patients were ranged between 1% and 31% with an overall meta-analysis prevalence of 16.5% and high heterogeneity (I2: 98.7%, p: 0.000). Patients with ALS showed a PBA prevalence of 38.5%, which is higher than other neurodegenerative diseases (CI 95%: 31%-45%, I2: 61.4%, p: 0.034). Moreover, the prevalence of PBA in MS patients in the analysis was 23.3% ranging between 11% and 35% with high-level heterogeneity according to the I2 value (I2: 98.9%, p: 0.000). Also, our meta-analysis showed that the PBA prevalence in AD was 16.4% (CI 95%: 7%-25%) with high heterogeneity (I2: 97.8%, p: 0.000). CONCLUSION: This review showed that PBA is common in patients with neurodegenerative diseases including PD, AD, MS, and especially ALS. Due to the lack of proper recognition, medication and treatment would not be effective and sufficient. Therefore, it can dramatically lower the quality of life in PBA patients and decrease their social interactions.

"It's Hard, but We Could Kind of Laugh About It": Exploring the Role of Humor in Brain Cancer Caregiving.

Research exploring the benefits of humor for caregivers is limited and, to date, no qualitative studies have explored the role of humor in brain cancer caregiving. To address this gap, we analyzed transcripts from twenty-one in-depth telephone interviews conducted with brain cancer caregivers from a strengths perspective. Thematic analysis using Braun and Clarke's method revealed that humor functions as (1) an innate element of the self and relationship, (2) an expression of mutual connection and understanding, (3) a way of managing difficult or awkward moments, (4) a form of avoidance or a welcome distraction, and may be (5) helpful, or unhelpful, depending on where someone is in the brain cancer trajectory. Findings suggest that humor represents an important yet complex individual and family strength for health service providers to identify and build upon.

Trigeminal schwannoma presenting as a gelastic seizure: no laughing matter.

We present the case of a 66 year old gentleman with trigeminal schwannoma whose only presenting feature was a single gelastic seizure. This is the first case report of pathological laughter in trigeminal schwannoma in the absence of other trigeminal, brainstem, cerebellar or other cranial nerve dysfunction.

Intervenções riso-clínicas: entre palhaços e trabalhadores na educação permanente em saúde mental / Laugh-clinic interventions: between clowns and workers on permanent education in mental health

O presente artigo constitui um relato da pesquisa desenvolvida pela primeira autora em seu mestrado em psicologia social e institucional tendo como tema os encontros da pesquisadora, como palhaça e como psicóloga, com os trabalhadores nos espaços de práticas de educação permanente em saúde mental. Tais encontros acontecem a partir das intervenções da palhaça Dulcinóia, encarnada na pesquisadora através da máscara do nariz vermelho, tanto nas práticas de educação permanente em saúde mental como no exercício da pesquisa. Estas intervenções foram designadas como intervenções riso-clínicas. Assim, discutem-se as relações da palhaçaria com a saúde mental a partir das experiências vividas e as possíveis invenções sobre diferentes modos de trabalhar e de cuidar neste contexto. As experiências são narradas e desenvolvidas a partir da metodologia do ensaio sobre as cenas vividas. Como conclusão, destacamos a importância da presença da figura do palhaço e do signo do humor como produtores de possíveis transformações e de uma ampliação do olhar sobre o trabalho em saúde mental.(AU)

This article is a report of the research developed by the first author in her master degree in social and institutional psychology, having as its theme the researcher's meetings as clown and as psychologist with the workers in the spaces of permanent education practices in mental health. Such meetings take place from the interventions of the clown Dulcinóia, embodied in the researcher through the mask of the red nose, both at the permanent education practices in mental health and in the exercise of the research. These interventions were termed laugh-clinic interventions. Thus, the relationships of clown techniques with mental health from the lived experiences and possible inventions on different ways of working and caring in this context are discussed. The experiences are narrated and developed from the methodology of the essay on the lived scenes. As a conclusion, we highlight the importante of clown´s figure presence and sign of humor as producers of possible transformations and extention of the look on mental health work.(AU)

Este artículo es un relato de la investigación desarrollada por la primera autora en su maestría em psicología social e institucional y tiene como tema sus encuentros, como payasa y psicóloga, con trabajadores de espacios de prácticas de educación permanente en salud mental. Estos encuentros se han dado a partir de las intervenciones de la payasa Dulcinoia, encarnada en la autora por medio de la máscara de la nariz roja, tanto en las prácticas de educación permanente en salud mental como en el ejercicio de la investigación. Estas actividades se han dado a llamar intervenciones riso-clínicas. Así, el estudio discute las relaciones de payasería y salud mental a partir de experiencias vividas y de ideas sobre diferentes modos de trabajar y cuidar en este contexto. Las experiencias se narran y se desarrollan a partir de la metodologia del ensayo sobre las escenas vividas. Como conclusión, destacamos la importancia de la presencia de la figura del payaso, así como del signo del humor como motivadores de posibles transformaciones que amplíen la mirada sobre el trabajo en salud mental.(AU)

Pathological laughter and crying: insights from lesion network-symptom-mapping.

The study of pathological laughter and crying (PLC) allows insights into the neural basis of laughter and crying, two hallmarks of human nature. PLC is defined by brief, intense and frequent episodes of uncontrollable laughter or crying provoked by trivial stimuli. It occurs secondary to CNS disorders such as stroke, tumours or neurodegenerative diseases. Based on case studies reporting various lesions locations, PLC has been conceptualized as dysfunction in a cortico-limbic-subcortico-thalamo-ponto-cerebellar network. To test whether the heterogeneous lesion locations are indeed linked in a common network, we applied 'lesion network-symptom-mapping' to 70 focal lesions identified in a systematic literature search for case reports of PLC. In lesion network-symptom-mapping normative connectome data (resting state functional MRI, n = 100) is used to identify the brain regions that are likely affected by diaschisis based on the lesion locations. With lesion network-symptom-mapping we were able to identify a common network specific for PLC when compared with a control cohort (n = 270). This bilateral network is characterized by positive connectivity to the cingulate and temporomesial cortices, striatum, hypothalamus, mesencephalon and pons, and negative connectivity to the primary motor and sensory cortices. In the most influential pathophysiological model of PLC, a centre for the control and coordination of facial expressions, respiration and vocalization in the periaqueductal grey is assumed, which is controlled via two pathways: an emotional system that exerts excitatory control of the periaqueductal grey descending from the temporal and frontal lobes, basal ganglia and hypothalamus; and a volitional system descending from the lateral premotor cortices that can suppress laughter or crying. To test whether the positive and negative PLC subnetworks identified in our analyses can indeed be related to an emotional system and a volitional system, we identified lesions causing emotional (n = 15) or volitional facial paresis (n = 46) in a second literature search. Patients with emotional facial paresis show preserved volitional movements but cannot trigger emotional movements in the affected hemiface, while the reverse is true for volitional facial paresis. Importantly, these lesions map differentially onto the PLC subnetworks: the 'positive PLC subnetwork' is part of the emotional system and the 'negative PLC subnetwork' overlaps with the volitional system for the control of facial movements. Based on this network analysis we propose a two-hit model of PLC: a combination of direct lesion and indirect diaschisis effects cause PLC through the loss of inhibitory cortical control of a dysfunctional emotional system.

Successful stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of a patient with mesial frontal region-originated mirthful gelastic seizure.

Gelastic seizures (GS), characterized by automatic bouts of unnatural stereotyped laughter and commonly recognized as the hallmark of hypothalamic hamartoma, is rarely associated with cortical epileptogenic focus. Whether there is a dissociation of the motor program of laughter and the experience of mirth and the symptomatogenic zone for ictal laughter with or without mirth are still unclear. We report a patient with drug-resistant mirthful GS who receive a comprehensive investigation of stereoelectroencephalography recording and electrocortical stimulation. Mirthful GS were confirmed to originate from the mesial region of the right superior frontal gyrus, not involving the mesial temporal lobe structures. The patient has been entirely seizure-free after stereoelectroencephalography-guided radiofrequency thermocoagulation. We conclude that the superior frontal gyrus serves as the symptomatogenic zone of ictal laughter and GS with or without mirth share a common neural network.

Neuropsiquiatría del síndrome de Susac: a propósito de un caso / Neuropsychiatry of Susac Syndrome: a Case Report

RESUMEN El síndrome de Susac es una entidad clínica poco frecuente, posiblemente mediada por un proceso autoinmune; la tríada clásica se compone de retinopatía, disminución en la agudeza auditiva y síntomas neuropsiquiátricos (encefalopatía). Hay pocos casos descritos con sintomatología neuropsiquiátrica como la sintomatología principal. Presentamos un caso de síndrome de Susac, que corresponde a una mujer de 34 arios, con predominio de sintomatologia neuropsiquiátrica, caracterizada por un síndrome de Klüver-Bucy parcial, un síndrome apático, risa y llanto patológico y alteraciones cognitivas de predominio atencional; dichos síntomas mejoraron cualitativamente con el uso de terapia inmunológica. Este caso revela la importancia de las manifestaciones neuropsiquiátricas como presentación clínica en pacientes con entidades neurológicas.

ABSTRACT Susac syndrome is a rare clinical condition, possibly mediated by an autoimmune process; the classic triad is composed of retinopathy, decreased hearing acuity and neuropsychiatric symptoms (encephalopathy). There are few cases reported with neuropsychiatric symptoms as the main manifestation. We present a case of Susac syndrome in a 34-year-old female with a predominance of neuropsychiatric symptoms, characterised by partial Klüver-Bucy syndrome, apathy syndrome, pathological laughter and crying, and cognitive dysfunction predominantly affecting attention, which showed a qualitative improvement with the use of immunological therapy. This case report highlights the importance of neuropsychiatric manifestations as clinical presentation in patients with neurological conditions.

Desaquendando o humor na pista de batalha: convites promovidos por travestis de baixa renda / Unleashing humor on the battlefield: invitations promoted by low-income transvestites / Desaquendando el humor en el campo de batalla: invitaciones promovidas por travestis de bajos ingresos / Dévoiler l'humour sur le champ de bataille: invitations faites par des travestis à faible revenu

Propõe-se analisar, por meio de percurso etnográfico, o humor de um grupo de travestis do interior de São Paulo, tendo por aporte teórico a psicanálise. Tem-se como objetivo específico compreender: o uso do pajubá, dialeto partilhado pelo grupo, no humor produzido por essas pessoas; as funções do humor nas relações estabelecidas com a heteronormatividade. Dialogaremos com excertos de entrevistas e situações observadas ao longo de trabalho de campo. A partir de análise temática, identificaram-se várias dimensões do humor criado entre elas, a saber: constituição de modos de sociabilidade, despatologização das travestilidades, indicação do caráter performático do binarismo de gêneros, transformação da angústia em riso e celebração da vida.

The aim is to analyze the humor among a group of transvestites in the inland of São Paulo state with psychoanalysis through an ethnographic route as its theoretical support. The specific objectives are to understand: the use of pajubá, a dialect shared by the group, in the humor produced by these people and the functions of humor in the relations established with heteronormativity. We will dialogue with excerpts from interviews and situations observed during fieldwork. Based on thematic analysis, several dimensions of the humor produced among them were identified, namely: constitution of modes of sociability, depathologization of transvestites, indication of the performance character of gender binarism, transformation of anguish into laughter and celebration of life.

Se propone analizar, a través de una investigación etnográfica, el humor de un grupo de travestis del interior de São Paulo, con el soporte teórico del psicoanálisis. Sus objetivos específicos son comprender: el uso del pajubá, un dialecto compartido por el grupo, en el humor que producen estas personas; las funciones del humor en las relaciones establecidas con la heteronormatividad. Dialogaremos con extractos de entrevistas y situaciones observadas durante el trabajo de campo. A partir del análisis temático, se identificaron varias dimensiones del humor producido, a saber: constitución de modos de sociabilidad, despatologización de la travestilidad, indicio del carácter de performance del binarismo de género, transformación de la angustia en risa y celebración de la vida.

On se propose à analyser, à travers un parcours ethnographique, ayant comme base théorique la psychanalyse, l'humour d'un groupe de travestis habitant la province de l'État de São Paulo, au Brésil. Le but spécifique de cette étude est de comprendre: l'utilisation du pajubá, un dialecte partagé par le groupe, lors de la production de l'humour et les fonctions de l'humour dans les relations établies avec l'hétéronormativité. On discute des extraits d'entretiens et des situations repérées lors du travail de terrain réalisé. À partir de l'analyse thematique, ont été identifiées plusieurs dimensions de l'humour créé par les travestis à l'intérieur de leur groupe, à savoir: la constitution de modes de sociabilité, la dépathologisation du travestissement, l'indication de la nature performative du binarisme de genres, la transformation de l'angoisse en rire et la célébration de la vie.

[A Case of Trochlear Nerve Neurinoma Presenting with Pathological Laughter].

Trochlear nerve neurinomas are rare and solitary tumors without neurofibromatosis are extremely rare. We report a case of trochlear nerve neurinoma presenting with pathological laughter and diplopia. A 40-year-old male patient presented with diplopia and pathological laughter 2 months before admission. MRI showed a multicystic enhanced mass in the left tentorial incisura compressing the midbrain and the upper pons. The tumor was excised using the left trans-Sylvian approach with partial uncal resection. After excision of the tumor, the left trochlear nerve was identified on the surface of the lateral midbrain. The nerve was connected to the tumor. Pathological laughter completely resolved after the operation. This is the second reported case of trochlear nerve neurinoma presenting with pathological laughter. The lesion responsible for pathological laughter could be the midbrain, upper pons, diencephalon, or all of these.

The importance of humour in oncology: a survey of patients undergoing radiotherapy.

Background: Humour has long been considered an important coping tool for patients with cancer, but published quantitative data about its significance are limited. The purpose of our study was to survey patients with cancer undergoing radiotherapy regarding their opinions about the use of humour in their care. Methods: An anonymous 35-item questionnaire evaluating the patient experience, including the value of humour, was developed by an interdisciplinary team of health care providers (hcps) working within the Radiation Medicine program. This anonymous, voluntary, paper-based survey for self-completion required approximately 10 minutes to finish and was administered during the fall of 2018 and the spring of 2019. Results: For the 199 patients who completed the survey [108 women, 89 men (2 respondents did not specify)], median age was 68 years. That group represents approximately 30%-35% of the patients on treatment during the study period. Almost all respondents (86%) indicated that, during their visits to the cancer centre, it was "somewhat important" or "very important" for health care providers (hcps) to use appropriate humour, and 61% of respondents indicated using humour "frequently" or "always" when dealing with their individual cancers. Most respondents (79%) said that humour decreased anxiety, and 86% indicated that laughing was considered "somewhat important" or "very important." Approximately 4% of respondents even listed "sense of humour" as being the most important quality that they looked for in their interactions with their hcps. Conclusions: Cancer patients undergoing radiotherapy clearly view humour as being important for coping and dealing with their disease, and oncology hcps should routinely consider incorporating the use of appropriate humour into the care that they provide.

A young man with convulsive laughter. / En ung mann med krampaktig latter.

BACKGROUND: Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) can manifest with a wide range of neurological and psychiatric symptoms. CASE PRESENTATION: A previously healthy man in his late twenties was admitted several times over the course of half a year. He had acute episodes of reduced consciousness, involuntary movements and psychotic symptoms (e.g. hallucinations and delusions). Initial examinations were normal except for a positive urine drug screen (tetrahydrocannabinol), and the patient was diagnosed with cannabinoid intoxication. During the next admission cerebrospinal fluid analysis showed mild pleocytosis. Screening for anti-neuronal antibodies was negative, but anti-thyroid peroxidase antibodies were detected in serum and cerebrospinal fluid. He was successfully given steroid treatment on a tentative diagnosis of SREAT, but relapsed when the steroids were discontinued. After receiving a prolonged steroid treatment with gradual dose reduction over a year, he remains symptom-free 18 months after treatment discontinuation. INTERPRETATION: The diagnostic delay might have been mitigated with an earlier inclusion of neuroimmunological disorders in the differential diagnosis. Unexplained pleocytosis in the cerebrospinal fluid in the presence of paroxysmal neuropsychiatric symptoms should trigger an investigation that includes autoimmune encephalopathies.

Humour and laughing in patients with prolonged incurable cancer: an ethnographic study in a comprehensive cancer centre.

PURPOSE: Most people are familiar with the expression 'laughter is the best medicine'. By enhancing cognitive flexibility and strengthening relationships, laughter can be considered a holistic care-approach. Yet, in medical oncology, especially the palliative phase, using humour can be considered inappropriate or taboo. We aimed to explore the acceptability and functions of humour and laughter in patients with prolonged incurable cancer. METHODS: This study was performed in a Dutch Comprehensive Cancer Centre. We included four short conversations with patients, eighteen in-depth patient-interviews and eleven observational fieldnotes in which humour was a major topic of the conversation. We further administered an online questionnaire to thirty-three oncology clinicians about their experiences with humour. Qualitative data were thematically analysed. We specifically distinguished between humour and laughter. RESULTS: Nearly all specialists reported using humour (97%), and all reported sometimes laughing during consultations; 83% experienced a positive effect of laughter. These results were in line with patients' experiences: Patients noted that humour always stayed alive despite medical difficulties. Apart from this human aspect, patients also used humour to broach difficult topics and downplay challenges. Patients and specialists acknowledged that using humour is sometimes inappropriate, partly because they did not always share the same humour. Laughter, in contrast, was regarded as 'lighter' than humour, and could, accordingly, more easily be implemented. Specialists cautioned against patients using laughter to avoid broaching difficult topics. CONCLUSION: Many conversations were full of laughter. Hierarchy as usually experienced between healthcare professionals and patients/relatives seemed to disappear when using laughter. If applied appropriately, adding shared laughter may help optimize shared decision-making.