TREATMENT OF UNCONTROLLED CRYING AFTER STROKE

Uncontrolled crying after stroke is a disturbance of the motor concomitants of emotional affect. It manifests as stereotyped outbursts of crying that are excessive to an appropriate emotional response. The episodes can be triggered by almost any kind of emotional stimulus (happiness, excitement, sadness, just being looked at or talked to, the sight of a doctor, etc.) and can even occur without any obvious external or internal stimulus. The condition is socially embarrassing, and in the most severely affected patients the crying episodes can be so violent that they interfere with rehabilitation. Although frequent (1-year incidence is 20%), the condition often goes unrecognised because patients and relatives rarely complain about it spontaneously. Effective treatment has now been documented in 3 controlled studies of tricyclic antidepressants and the selective serotonin reuptake inhibitor citalopram. There seems to be a rationale for the latter approach to treatment, in that post-stroke pathological crying may be attributable to stroke-induced partial destruction of the serotonergic raphe nuclei in the brainstem or their ascending projections to the hemispheres. Although our knowledge of the aetiology and treatment of the condition is limited, and the need for further study is considerable, the present treatment possibilities can significantly improve quality of life for patients with this socially embarrassing and sometimes debilitating condition.