Journal of the Neurological Sciences 169 (1999) 22–25 www.elsevier.com / locate / jns The emotional lability questionnaire: a new measure of emotional lability in amyotrophic lateral sclerosis a, a a b * I.C. Newsom-Davis , S. Abrahams , L.H. Goldstein , P.N. Leigh a Department of Psychology, Institute of Psychiatry and King’ s College School of Medicine and Dentistry, London SE58AF, UK b Department of Clinical Neurosciences, Institute of Psychiatry and King’ s College School of Medicine and Dentistry, London SE58AF, UK Abstract In an ALS Clinic, use of the Pathological Laughter and Crying Scale of Robinson et al. [Robinson RG, Parikh RM, Lipsey JR, Starkstein SE, Price TR. Pathological laughter and crying following stroke: validation of a measurement scale and double-blind treatment study. American Journal of Psychiatry 1993;150(2):286–293] revealed several problems: reliance on self-rating, insufficient period of assessment, inadequate exploration of ‘appropriateness of emotion’, lack of an item for abnormal smiling, amusement rather than happiness being the cause of laughter in ALS, and a frequency-based rating system. The necessary modifications produced a new Emotional Lability Questionnaire (ELQ) that was tested in 43 ALS patients and 43 healthy controls. The self-rated version of the ELQ was administered as a structured interview to each participant, and the independent-relationship between subscales of the ELQ for both versions, thus confirming its internal validity. Greater emotional lability appeared associated with pseudobulbar symptoms. The question why 14 patients rated themselves as severely labile in the crying domain alone and four in the laughter domain alone, required further study.  1999 Elsevier Science B.V. All rights reserved. Keywords: Emotional lability; Pathological laughter and crying; Amyotrophic lateral sclerosis; Pseudobulbar 1. Introduction population. This study aimed to develop a new ques- tionnaire to better describe and measure EL in ALS. Loss of control of emotion is a relatively common affliction associated with a variety of central nervous system disorders [1,2]. It is known that the finer degrees of emotional control decline with increasing age and that 2. Methods disease in the frontal lobe, temporal lobe, third ventricle, hypothalamus, putamen, caudate nucleus and brain stem 2.1. Design of the instrument can all bring on so-called ‘pathological laughter and crying’ (PLC). Although emotional lability (EL) was first In the absence of a detailed measure of EL in ALS, the reported in MND in the last century, our understanding of Pathological Laughter and Crying Scale [5] has been used it remains relatively poor. Gallagher [3] found that the at the King’s MND Care and Research Centre. Use of this symptoms occur in approximately 10–20% of ALS pa- scale with ALS patients highlighted the following omis- tients, most often in those with pseudobulbar symp- sions and other problems, which led to the specified tomatology. There are few existing measures of EL and the modifications: majority of these have been designed for use with other clinical populations. The sole ALS-specific questionnaire 1. Reliance on self-rating. Patients and their carers were currently available [4] is a useful clinical instrument, but often noted to disagree about levels of EL. An lacks the detail necessary for an experimental exploration independent-rater version of the questionnaire was of the nature and extent of emotional lability in this added to the new ELQ. 2. Insufficient period of assessment. ALS patients with *Corresponding author. EL may experience episodes very infrequently. This 0022-510X / 99 / $ – see front matter  1999 Elsevier Science B.V. All rights reserved. PII: S0022-510X(99)00211-7