Eliciting Smiles and Laughter During Intraoperative Electric Stimulation of the Cingulum: Surgical Scenario.

Laughter has a major role in daily social interactions; consequently, its biologic bases have been previously studied. Nevertheless, its cerebral representation remains unclear. The most accepted hypothesis has postulated that laughter has 2 components: mirth, related to the temporal and frontal neocortical areas, and motor aspect, related to the limbic system and brainstem. Furthermore, in prior studies, laughter has been elicited during electric stimulation with depth electrodes in the supplementary motor area and the cingulum. This Video 1 reports resection of a right superior frontal gyrus diffuse astrocytoma (isocitrate dehydrogenase mutant, World Health Organization grade II) with awake intraoperative electric cortical and subcortical stimulation mapping. Diffusion tensor imaging (DTI) tractography, including all the tracts in relation to the tumor, was obtained preoperatively and postoperatively. Stimulation of the cingulum medially and inferiorly to the tumor elicited a patient's smile and laugh without mirth or merriment. Also, this point correlated with the reconstructed cingulum in the intraoperatively navigated DTI tractography. In conclusion, these findings support the anatomic subdivision of the laughter's mechanism and the role of the cingulum in its motor component. Furthermore, smiles and laughter could be useful functional landmarks to identify the cingulum during subcortical mapping. Although it remains unclear whether pursuing resection beyond this point would have caused permanent postoperative deficits, considering laughter's role in social interaction and other emotion-processing functions associated with the cingulum, in the future it could be potentially considered a functional limit of the resection of intrinsic tumors.

The Impact of Mirth-Inducing Ventral Striatal Deep Brain Stimulation on Functional and Effective Connectivity.

Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is an investigational therapy for treatment-resistant obsessive-compulsive disorder. The ability of VC/VS DBS to evoke spontaneous mirth in patients, often accompanied by smiling and laughter, is clinically well documented. However, the neural correlates of DBS-evoked mirth remain poorly characterized. Patients undergoing VC/VS DBS surgery underwent intraoperative evaluation in which mirth-inducing and non-mirth-inducing stimulation localizations were identified. Using dynamic causal modeling (DCM) for fMRI, the effect of mirth-inducing DBS on functional and effective connectivity among established nodes in limbic cortico-striato-thalamo-cortical (CSTC) circuitry was investigated. Both mirth-inducing and non-mirth-inducing VC/VS DBS consistently resulted (conjunction, global null, family-wise error-corrected P < 0.05) in activation of amygdala, ventral striatum, and mediodorsal thalamus. However, only mirth-inducing DBS resulted in functional inhibition of anterior cingulate cortex. Dynamic causal modeling revealed that mirth-inducing DBS enhanced effective connectivity from anterior cingulate to ventral striatum, while attenuating connectivity from thalamus to ventral striatum relative to non-mirth-inducing stimulation. These results suggest that DBS-evoked mood elevation is accompanied by distinct patterns of limbic thalamocortical connectivity. Using the novel combination of DBS-evoked mood alteration and functional MRI in human subjects, we provide new insights into the network-level mechanisms that influence affect.

Intraoperative smile in a multiple sclerosis patient with medication-refractory tremor.

Deep brain stimulation has been utilized to improve disease symptoms in patients with Parkinson's disease, dystonia, essential tremor, and other neuropsychiatric syndromes such as depression and obsessive compulsive disorder. Deep brain stimulation has also been observed to improve tremor for select patients with multiple sclerosis. During intraoperative stimulation in these multiple sclerosis patients, researchers have observed a wide spectrum of motor and sensory phenomena, but no stimulation-induced emotional responses have been reported. We detailed intraoperative smiling associated with stimulation of the ventralis oralis anterior/ventralis oralis posterior border region of the left thalamus.  A single patient with medication-resistant multiple sclerosis tremor experienced smiling, laughing, and subjective euphoria during intraoperative stimulation of the left thalamus. Specifically, during intraoperative stimulation of the left thalamic ventralis oralis anterior border, the patient developed a contralateral smile which progressed to a bilateral smile and was accompanied by a feeling of subjective happiness. The smile habituated in approximately 60 seconds and it was reproducible on a repeat stimulation. The patient could subjectively feel the facial movement, and, at higher voltages, the movement was described as a pulling sensation. Stimulation of the anterior ventralis oralis anterior border of the left thalamus in an multiple sclerosis patient produced a unilateral smile that rapidly developed into a bilateral smile accompanied by euphoria. There were presumed capsular side effects at higher voltages. The exact mechanism by which stimulation of the thalamus produced a smile and mood elevation is unknown, but we speculate that the smile could be induced by stimulation of corticobulbar fibers arising from the caudal cingulate motor area connecting the contralateral facial nerve nucleus.

Neuromodulation of emotion using functional electrical stimulation applied to facial muscles.

BACKGROUND AND OBJECTIVE: Major depressive disorder (MDD) is a common condition for which available pharmaceutical treatments are not always effective and can have side-effects. Therefore, alternative and/or complementary MDD treatments are needed. Research on facial expressions has shown that facial movements can induce the corresponding emotions, particularly when specific attention is paid to voluntarily activating muscles that are typically only activated involuntarily while expressing emotions. We hypothesized that functional electrical stimulation (FES) applied to facial muscles may enhance this effect due to its ability to modulate central nervous system plasticity. Thus, applying FES to the facial muscles associated with smiling (including the "Duchenne marker") may increase the activity of subcortical nuclei related to positive emotions and counteract symptoms of depression. METHODS: Twelve able-bodied subjects received FES and were compared with a group of 12 control subjects. Both groups underwent the same experimental procedures involving a cognitive task, and a deception was used such that subjects were unaware that the objective was to modulate mood. Assessments with the Positive and Negative Affect Schedule-Expanded Form (PANAS-X) were administered before and after the experiment. RESULTS: No significant between-group differences were found in the change scores for our primary outcomes, the PANAS-X item "happy," and aggregate scores "Joviality" and "Positive Affect." Significant differences were, however, detected for secondary outcomes "determined," "daring," "scared," and "concentrating." CONCLUSIONS: These results suggest that modulating emotion using FES may be possible, but is difficult to target accurately. Further work is warranted to explore FES applications to MDD.

Validity and reliability of Oral Impacts on Daily Performances Frequency Scale: a cross-sectional survey among adolescents.

AIM: To examine reliability and validity of an abbreviated version of Oral Impacts on Daily Performances (OIDP) questionnaire and to analyze the interrelationship among OIDP scores, socio-demographic characteristics and oral health status among 12-15 year old adolescents in Davanagere city, Karnataka, India. METHOD: The descriptive cross-sectional survey was conducted among 900 adolescents aged between 12-15 years. The study subjects were randomly selected from six high schools. Selected subjects completed a survey instrument designed to measure subjective oral health indicators including the eight-item OIDP frequency scores. The study participants were clinically examined for dental caries and completed a self-administered questionnaire about demographic information and oral behaviors. RESULTS: 44% of the students reported at least one oral impact in the last six months. Cronbach's alpha for the OIDP frequency items was 0.81. Eating was the most common performance affected (33%) followed by cleaning teeth (22%) and speaking (20%). The severity of impacts was low for relaxing and carrying out works. CONCLUSION: The OIDP frequency score have acceptable psychometric properties in the context of an oral health survey among 12-15 year old adolescents.

La risa: diferencias según el género / Laughter: gender differences

La risa se acompaña de numerosos beneficios fisiológicos y psicológicos. Aunque las mujeres ríen más que los varones, la frecuencia diaria de risas no parece diferir. La risa es un indicador de vitalidad de la familia y de la salud de la pareja. Resulta muy atractiva en el aspecto interpersonal, especialmente para las mujeres. Los varones utilizan mucho más el humor y la risa cuando se trata de discutir sobre temas sensibles de salud. En las mujeres, la risa está más relacionada con la esfera social y se utiliza para afrontar situaciones de estrés. La facilitación de la risa en la consulta puede ser muy útil a la hora de ofrecer determinados mensajes. Tener en cuenta las posibles diferencias en el uso del humor y de la risa por varones y mujeres puede ayudar a mejorar la relación con el paciente y optimizar su aplicación clínica en el ámbito de la educación y la atención sociosanitarias(AU)

Laughter is associated to many physiological and psychological benefits. Although women laugh more than men do, the daily frequency of laughter does not seem to differ. Laughter in all its forms and manifestations is an indicator of family vitality and healthy couples. Laughter is very attractive at the interpersonal level, especially for women. Men use humor much more and laughter when it comes to discussing sensitive health issues. In women, laughter would be more associated with greater social support in relationships and as a tool to cope with stress. Inviting laughter in the doctor's office may be very useful when directing certain messages on therapeutic management. Taking into account possible gender differences in the use of humor and laughter may help to improve the relationship with the patient and optimize the clinical application of laughter in health care and education setting(AU)

[Laughter: gender differences]. / La risa: diferencias según el género.

Laughter is associated to many physiological and psychological benefits. Although women laugh more than men do, the daily frequency of laughter does not seem to differ. Laughter in all its forms and manifestations is an indicator of family vitality and healthy couples. Laughter is very attractive at the interpersonal level, especially for women. Men use humor much more and laughter when it comes to discussing sensitive health issues. In women, laughter would be more associated with greater social support in relationships and as a tool to cope with stress. Inviting laughter in the doctor's office may be very useful when directing certain messages on therapeutic management. Taking into account possible gender differences in the use of humor and laughter may help to improve the relationship with the patient and optimize the clinical application of laughter in health care and education setting.

Smile and laughter induction and intraoperative predictors of response to deep brain stimulation for obsessive-compulsive disorder.

We recently treated six patients for OCD utilizing deep brain stimulation (DBS) of the anterior limb of the internal capsule and the nucleus accumbens region (ALIC-NA). We individually tested leads via a scripted intraoperative protocol designed to determine DBS-induced side effects and mood changes. We previously published qualitative data regarding our observations of induced emotional behaviors in our first five subjects. We have now studied these same behaviors in the full cohort of six patients over 2 years of follow-up and have examined the relationship of these behaviors to intraoperative mood changes and postoperative clinical outcomes. Five patients experienced at least one smile response during testing. At higher voltages of stimulation, some of these smiles progressed to natural laughter. Smiles and laughter were associated with mood elevation. At stimulation locations at which smiles were observed, voltage and mood were significantly correlated (p=0.0004 for right brain and p<0.0001 for left brain). In contrast, at contacts where smiles were not observed, mood was negatively correlated with voltage (p=0.0591 for right brain and p=0.0086 for left). Smile and laughter-inducing sites were located relatively medial, posterior, and deep in the ALIC-NA. The presence of stimulation induced laughter predicted improvement in OCD symptoms at 2 years. The higher the percentage of laugh conditions experienced in an individual patient, the greater the reduction in YBOCS (24 months, p=0.034). Other correlations between clinical outcomes and percent of smile/laugh conditions were not significant. These stimulation-induced behaviors were less frequently observed with 1 and 2-month postoperative test stimulation and were not observed at subsequent test stimulation sessions. Intraoperative stimulation-induced laughter may predict long-term OCD response to DBS. Identifying other potential response predictors for OCD will become increasingly important as more patients are implanted with DBS devices. A larger study is needed to better delineate the relationship between induced intraoperative and postoperative emotional behavior and clinical outcome in patients treated with DBS therapy.

Orbitofrontal and hippocampal contributions to memory for face-name associations: the rewarding power of a smile.

Memory processes can be enhanced by reward, and social signals such a smiling face can be rewarding to humans. Using event-related functional MRI (fMRI), we investigated the rewarding effect of a simple smile during the encoding and retrieval of face-name associations. During encoding, participants viewed smiling or neutral faces, each paired with a name, and during retrieval, only names were presented, and participants retrieved the associated facial expressions. Successful memory activity of face-name associations was identified by comparing remembered vs. forgotten trials during both encoding and retrieval, and the effect of a smile was identified by comparing successful memory trials for smiling vs. neutral faces. The study yielded three main findings. First, behavioral results showed that the retrieval of face-name associations was more accurate and faster for smiling than neutral faces. Second, the orbitofrontal cortex and the hippocampus showed successful encoding and retrieval activations, which were greater for smiling than neutral faces. Third, functional connectivity between the orbitofrontal cortex and the hippocampus during successful encoding and retrieval was stronger for smiling than neutral faces. As a part of the reward system, the orbitofrontal cortex may modulate memory processes of face-name associations mediated by the hippocampus. Interestingly, the effect of a smile during retrieval was found even though only names were presented as retrieval cues, suggesting that the effect was mediated by face imagery. Taken together, the results demonstrate how rewarding social signals from a smiling face can enhance relational memory for face-name associations.

Impacts on daily performances related to wearing orthodontic appliances.

OBJECTIVE: To assess the prevalence, intensity, and extent of the impacts on daily performances related to wearing different types of orthodontic appliances. MATERIALS AND METHODS: A total of 1657 students, 15 to 16 years old, were randomly selected from those attending all secondary schools in Bauru, São Paulo, Brazil. Only those wearing orthodontic appliances at the time of the survey were included. Face-to-face structured interviews were done to collect information about impacts on quality of life related to wearing orthodontic appliances, using the Oral Impact on Daily Performances (OIDP). Adolescents were also clinically examined to assess the type of orthodontic appliance they were wearing. Comparisons, by type of orthodontic appliance and covariables, were performed using nonparametric statistical tests. RESULTS: Three hundred fifty-seven adolescents (36.1% boys and 63.9% girls) undergoing orthodontic treatment participated in the study. The prevalence of condition-specific impacts related to wearing orthodontic appliances was 22.7%. Among adolescents with impacts related to wearing orthodontic appliances, 35.8% reported impacts of severe or very severe intensity and 90.1% reported impacts on only one daily performance, commonly eating or speaking. The prevalence, but not the intensity or the extent, of condition-specific impacts differed by type of orthodontic appliance (P = .001). CONCLUSIONS: One in four Brazilian adolescents undergoing orthodontic treatment reported side effects, specific impacts on daily living, related to wearing orthodontic appliances. Such impacts were higher among adolescents wearing fixed rather than removable or a combination of fixed and removable orthodontic appliances. This information could help to inform patients about the frequency and intensity of sociodental impacts during the course of their treatment.

Contralateral smile and laughter, but no mirth, induced by electrical stimulation of the cingulate cortex.

The cerebral representation of laughter is dissociated. The emotional aspects seem to be processed in the temporal lobe; whereas the motor features apparently rely on the frontal cortex. In a few prior studies of patients in whom laughter was elicited by electrical stimulation (ES), it always was associated with mirth. We report a patient in whom ES in the right cingulate gyrus elicited smile and laughter, but no mirth. At low voltages, smiling was seen first contralaterally and became bilateral with increasing currents. Our observation supports the concept of the motor representation of laughter in the mesial frontal cortex.

Randomized-controlled trial: effect of a reservoir biteguard on quality of life in xerostomia.

BACKGROUND: To assess the effect of a reservoir biteguard for artificial saliva on the oral health-related quality of life of patients with xerostomia. METHODS: Double-blind randomized placebo-controlled trial among 86 adults with xerostomia. Study group received the trial biteguard. Control group received a conventional biteguard. Outcomes were number of impacts and total scores as recorded by oral impacts on daily performances (OIDP). RESULTS: At 1-month follow up 84 people remained in the trial. The median number of impacts in the study and control groups was 3 and 4 respectively. The median total score was 6 and 12 respectively. In ANCOVA receipt of the reservoir biteguard reduced the number of impacts recorded by OIDP but there was no difference in the total score. CONCLUSIONS: Reservoir biteguards improved the quality of life of people with xerostomia by reducing the number of impacts on daily life.

[Laughter and smiling. The gesture between social philosophy and psychobiology]. / Riso e sorriso. Il gesto fra filosofia sociale e psicobiologia.

The human individual experiences his gestuality unaware, making it even more revelatory of his current state of mind. Certain actions represent innate behaviour, while others are discovered or assimilated during learning. The actions that signify the sending of any kind of message to another person, become "gestures". Laughter is an example of expressive behaviour and, as such, plays an important part in social interaction, insofar as it supplies signals that influence the response of other individuals. After a review of the philosophical and sociological interpretations inherent in laughing and smiling, the correlations between weeping, smiling and laughing are examined specifically from as ethological standpoint. The neurophysiological aspects whereby the crying, smiling and laughing mechanisms depend on a multifactorial control system, that implies the activation of limbic and frontal circuits, a motor cortex response and an activation of the autonomic response of the vegetative nervous system, correlated to the cortico-hypothalamic ways, are then examined. The pathological observations carried out in Man are identified with the study of psychomotor epilepsy in the context of "gelastic crises", cataleptic-gelolegic crises "and the pseudo-bulbar syndrome" with crying and spastic laughing. Finally, the possible therapeutic implications correlated with the laughing mechanism are discussed. In fact, the facial contractions, associated with the emotional experience connected with them, would appear to function as a standard brain signal. Interesting are the findings of changes in neuromediator and endorphin modifications implied in the neurophysiological smiling and laughing mechanism. A further basic element is the involvement of the autonomous system which can be correlated with the concept of the trophotropic response according to Hesse, with an increase in parasympathetic tone and reduction in sympathetic tone.