With multiple sclerosis (MS), some people may experience a condition known as pseudobulbar affect — a sudden burst of uncontrollable laughter or crying, often with no triggering event. Pseudobulbar affect is also sometimes called pathological laughing or crying, emotional liability, emotional incontinence, and emotionalism.
Although people with pseudobulbar affect are expressing emotion, they may not be feeling that emotion. For instance, they may start laughing even though they do not feel happy or amused. This laughing or crying is not under voluntary control and patients cannot readily stop the outburst, even if they would like to.
Understandably, an pseudobulbar affect epidode can be very distressing for MS patients, their families, and caretakers. Nevertheless, many patients do not report their symptoms to their physicians. Because of this, pseudobulbar affect is often undiagnosed and goes untreated. Some studies estimate pseudobulbar affect is prevalent in some 10 percent of all MS patients. Due to underreporting, however, it may actually be more common.
What causes pseudobulbar affect?
Pseudobulbar affect is caused by damage or injury to parts of the brain, such as the limbic and paralimbic systems, which regulate emotional expression. It may also involve the disruption of cellular communication. Brain injury and other neurodegenerative disorders, such as Parkinson’s and Alzheimer’s disease, can also cause pseudobulbar affect.
There are two tools, in the form of questionnaires, that help physicians diagnose pseudobulbar affect. One is the pathological laughing and crying scale (PLACS), in which the clinician interviews the patient. The other is the Center for Neurologic Study–lability scale (CNS–LS), which is a self-reporting questionnaire.
Physicians may do a thorough mental health history to rule out depression in people reporting this affect. In some cases, an electroencephalogram (EEG) may also be taken to rule out a rare form of epilepsy that can cause symptoms similar to those of pseudobulbar affect.
Since the pseudobular affect can cause embarrassment, distress and withdrawal from social activities, communication with family members and medical providers is the first step and an important part of treatment.
Selective serotonin reuptake inhibitors (SSRIs such as Prozac and Zoloft, as well as tricyclic anti-depressants like amitryptiline, can be effective in treating pseudobulbar affect. In 2010, a medication called Nuedexta was approved specifically for the treatment of pseudobulbar affect in MS patients.
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