Prevalence and Factors Related to Pathological Laughter and Crying in Patients With Amyotrophic Lateral Sclerosis

Objective: This study aimed to explore the prevalence and clinical correlates of pathological laughter and crying (PLC) in patients with amyotrophic lateral sclerosis (ALS).Methods: A total of 1,031 ALS patients were enrolled between August 2012 and August 2019. The PLC was recorded by a face-to-face interview. Other characteristics of patients, including depression, anxiety, cognition, and behavior function, were also evaluated. The potential associated factors of PLC were explored using forward binary regression analysis. Survival was analyzed in groups using propensity score matching (PSM) and Cox proportional hazards models.Results: The prevalence of PLC was 11.4% in all patients at baseline. Bulbar-onset and female patients had higher prevalence of PLC. The multivariate regression analysis indicated that PLC in ALS was associated with bulbar onset (p < 0.001), late disease stage (p < 0.001), and higher score in the Hamilton Depression Rating Scale (HDRS) (p = 0.012). The higher score of HDRS was significantly and independently associated with PLC occurrence in bulbar-onset patients (p = 0.032). The late disease stage was related to PLC occurrence in spinal-onset patients (p < 0.001). After comparison with matched pairs by using PSM, PLC at baseline had no impact on survival.Conclusion: PLC was not uncommon in ALS, especially in bulbar-onset and female patients. We highlighted that the emotional state other than cognitive function had possible relationship with PLC in ALS.

Physician Aid in Dying for Dementia: The Problem With the Early vs. Late Disease Stage Distinction

Background: Physician aid in dying (PAD) based on dementia is a contentious, highly debated topic. Several countries are considering extending their existing laws to include requests in incompetent patients based on a previously written advance directive. Discussions about this issue often invoke a distinction based on disease stage. The Dutch practice uses this distinction in classifications of dementia PAD cases and in guidance for clinicians. This paper explores the problem with this distinction for assessments of persons at the margins of competence.The Problem: Dutch guidance for clinicians uses an early vs. late-stage disease distinction to refer to requests from competent and incompetent persons. However, the use of disease stages is problematic, both conceptually and empirically. Conceptually, because it goes against very functional model of competence that guidance recognizes. Empirically, because it creates problems for classifying and evaluating patients at the margins of competence.Possible Ways Forward: Classification of cases and guidance should be based on competence, not disease stage. This requires rethinking decision-making for patients with dementia. Several possibilities are described, ranging from redefining the scope and role of advance directives in this context to exploring different types of decision-making frameworks.

The reappraisal of Batson’s theory by isolated para-vertebral metastasis of hepatocellular carcinoma

The extra-hepatic metastasis of hepatocellular carcinoma (HCC) usually hints late disease stage and poor prognosis. However, we treated 5 unusual HCC patients with isolated para-vertebral metastasis by tumor excision and the surgical result is satisfactory during 3.5 years follow-up in mean. To explain why the unusual situation of isolated metastasis of HCC occurred, an alternative spreading route of cancer cells bypass pulmonary circulation and avoid pulmonary vascular filtration, the Batson’s plexus, was highly suspected. We supposed that isolated para-vetebral metastases seems not to mean a late disease stage, aggressive management made longer survival possible, and it was confirmed by our clinical experience.

The reappraisal of Batson’s theory by isolated para-vertebral metastasis of hepatocellular carcinoma

The extra-hepatic metastasis of hepatocellular carcinoma (HCC) usually hints late disease stage and poor prognosis. However, we treated 5 unusual HCC patients with isolated para-vertebral metastasis by tumor excision and the surgical result is satisfactory during 3.5 years follow-up in mean. To explain why the unusual situation of isolated metastasis of HCC occurred, an alternative spreading route of cancer cells bypass pulmonary circulation and avoid pulmonary vascular filtration, the Batson’s plexus, was highly suspected. We supposed that isolated para-vetebral metastases seems not to mean a late disease stage, aggressive management made longer survival possible, and it was confirmed by our clinical experience.