Early Detection of Pseudobulbar Affect May Help Ease MS Symptom

1st newsletter gives info on managing uncontrolled crying, laughing

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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In its inaugural issue, a publication from The Gerontological Society of America provides information about recognizing and managing pseudobulbar affect — uncontrolled outbursts of crying or laughing that the authors say are one of the most “underrecognized and undertreated” symptoms of multiple sclerosis (MS) and other neurological conditions.

The neurological symptom, known as PBA for short, is addressed in “Understanding Pseudobulbar Affect,” the first publication of the society‘s “Insights & Implications in Gerontology” series.

Pseudobulbar affect is characterized by outbursts of laughing or crying that are inappropriate for the social context and are not reflective of how a person actually feels. “For example, an experience that might typically result in a sad sigh could trigger uncontrolled weeping,” the newsletter states.

“The symptoms of PBA can be severe, with persistent, unremitting episodes having a sudden or unpredictable onset,” George T. Grossberg, MD, a professor and director of geriatric psychiatry at Saint Louis University School of Medicine, who helped develop the publication, said in a society press release.

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Emotionally Hard-wired: Pseudobulbar Affect and MS

The symptoms of pseudobulbar affect

These outbursts may last for just a few seconds or several minutes, and they can happen several times a day. The uncontrolled emotional nature of the outbursts can cause awkwardness and embarrassment in social situations, often leading people with this symptom to become withdrawn and isolated.

However, early detection and management of pseudobulbar affect can help minimize the impact of such symptoms and improve patients’ quality of life, according to the newsletter.

The precise causes of pseudobulbar affect remain incompletely understood, but the symptom is broadly thought to develop due to damage in the nervous system that causes problems with the neuronal circuitry — the working of the brain — that normally controls emotional reactions.

In addition to MS, the symptom can develop in a range of neurological disorders including amyotrophic lateral sclerosis (ALS), Parkinson’s disease, stroke, traumatic brain injury, and brain cancer. All told, 2–7 million people in the U.S. live with the symptoms of pseudobulbar affect, according to the publication.

Pseudobulbar affect is usually diagnosed through discussions about a patient’s history, but the newsletter notes that the symptom often is mistaken for mental health problems like depression.

While it can co-occur with depression, the two conditions often may be distinguished by certain characteristics, scientists note. For example, episodes of pseudobulbar affect are usually intense but brief, whereas depression is characterized by changes to mood that last weeks or months.

Standardized assessments such as the Center for Neurologic Study–Lability Scale (CNS-LS) and the Pathological Laughter and Crying Scale (PLACS), detailed in the publication, also may be useful for establishing a diagnosis of pseudobulbar affect, the newsletter developers said.

To identify this underrecognized symptom, “the assessment of patients with neurologic conditions should incorporate questions about mood and emotion, including assessment of whether responses to certain environments are out of proportion to what would be expected for other conditions such as anxiety and depression,” said Jill Farmer, a doctor of osteopathic medicine, an assistant professor of neurology at Drexel University College of Medicine, in Philadelphia, and a member of the newsletter’s content development faculty.

Even if PBA is diagnosed, this symptom is often undertreated, according to the newsletter.

A number of strategies are available, however, that can help manage pseudobulbar affect symptoms. Behavioral interventions like mindfulness are helpful for some patients. Better educating caregivers and other people about pseudobulbar affect — including talking about how the patient would like others to respond to outbursts — also can help make the symptom less of a nuisance in day-to-day life.

Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) is the only medication specifically approved to treat pseudobulbar affect in the U.S. It often is used as a first-line treatment. Other medications, including certain antidepressants, also may be helpful for managing this symptom.

Nuedexta is marketed by Avanir Pharmaceuticals, which provided funding to support this publication.

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