Nothing to Cough About: A Treatment for Involuntary Laughing and Crying

Dextromethorphan with quinidine appears safe and effective for a syndrome seen in neurological disorders.

Some patients with neurological disorders such as multiple sclerosis (MS) and amyotropic lateral sclerosis (ALS) experience involuntary episodes of laughing, crying, or both. These episodes have been variously termed as pathologic laughing and crying, emotional incontinence, and pseudobulbar affect. Controlled studies have demonstrated the efficacy of 30 mg of the cough medicine dextromethorphan (Dm), combined with 30 mg of the antiarrhythmic quinidine (Q; an inhibitor of cytochrome P450 2D6) to increase Dm levels. These researchers ascertained the safety and effectiveness of a much lower Q dose (10 mg). In a randomized, controlled, manufacturer-funded study, 326 patients with MS or ALS received 30 or 20 mg Dm combined with 10 mg Q (DmQ 30/…

Reviewing Author

Jonathan Silver, MD

Disclosures

RoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions

Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience

Leadership Positions in Professional SocietiesNorth American Brain Injury Association (Board Member); National Institute on Disability, Independent Living, and Rehabilitation Research (Chair of Data Monitoring Safety Board for study of donepezil on cognition after traumatic brain injury)

Jonathan Silver, MD

Disclosures

RoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions

Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience