Materiały źródłowe

• #1 Pseudobulbar affect – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/symptoms-causes/syc-20353737

  Pseudobulbar affect (PBA) is a condition that’s characterized by episodes of sudden uncontrollable and inappropriate laughing or crying. […] The primary sign of pseudobulbar affect (PBA) is frequent, involuntary and uncontrollable outbursts of crying or laughing that are exaggerated or not connected to your emotional state. […] The degree of the emotional response caused by PBA is often striking, with crying or laughing lasting up to several minutes. […] Because pseudobulbar affect often involves crying, the condition is frequently mistaken for depression. […] Severe symptoms of pseudobulbar affect (PBA) can cause embarrassment, social isolation, anxiety and depression.

• #2 Pseudobulbar Affect (PBA): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17928-pseudobulbar-affect-pba

  Pseudobulbar affect (PBA) involves uncontrolled or inappropriate episodes of laughing or crying. These emotional responses dont match the intensity of your inner feelings. PBA results from certain underlying neurological conditions. Its manageable with medication. […] Pseudobulbar affect (PBA) is a neurological condition that causes outbursts of uncontrolled or inappropriate laughing or crying. These episodes dont match your internal emotional state. PBA develops as the result of a brain injury or underlying neurological condition, such as amyotrophic lateral sclerosis (ALS). […] The main symptom of pseudobulbar affect is affects often crying or laughing that dont match your mood or the intensity of your mood. […] Pseudobulbar affect (PBA) can be difficult to diagnose. Healthcare providers often misdiagnose it as a mood disorder especially depression or bipolar disorder.

• #2 Pseudobulbar Affect (PBA): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17928-pseudobulbar-affect-pba

  The prognosis (outlook) for PBA varies. […] Left undiagnosed and untreated, people with PBA are at an increased risk of: Depression. Anxiety. Impaired social interaction. Decreased quality of life. […] Pseudobulbar affect is usually chronic (lifelong) since the underlying conditions that cause it are often chronic, such as multiple sclerosis or Alzheimers disease.

• #3

  https://www.geron.org/News-Events/GSA-News/Press-Room/Press-Releases/pseudobulbar-affect-an-often-overlooked-condition

  Pseudobulbar affect (PBA) is characterized by bouts of uncontrolled crying or laughing that are disproportionate or inappropriate to the social context and are not associated with depression or anxiety. […] The symptoms of PBA can be severe, with persistent, unremitting episodes having a sudden or unpredictable onset, explained George T. Grossberg, MD, a member of the newsletters content development faculty who is a professor and director of geriatric psychiatry at Saint Louis University School of Medicine. […] PBA symptoms can cause embarrassment for older adults and their family and caregivers resulting in restricted social interactions, withdrawal, and social isolation. Thus, older adults with neurologic disorders and PBA experience additional burden of disease and reduced quality of life.

• #3

  https://www.geron.org/News-Events/GSA-News/Press-Room/Press-Releases/pseudobulbar-affect-an-often-overlooked-condition

  Goals of treatment for PBA include reducing severity and frequency of episodes. Behavioral strategies should always be considered for patients and caregivers particularly when symptoms are mild or do not impact the patients quality of life and may be adequate for treatment of PBA. Pharmacologic options may also provide benefit for appropriate patients. Implementing nonpharmacologic behavioral strategies along with pharmacologic treatment may produce a synergistic effect.

• #4 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  Pseudobulbar affect (PBA) is a type of affect lability characterized by sudden, frequent, and uncontrollable episodes of crying and/or laughing. The disease states most frequently associated with PBA are Alzheimers disease, amyotrophic lateral sclerosis, multiple sclerosis, Parkinsons disease, stroke, and traumatic brain injury. […] PBA affects about 1.5 million people in the United States; many cases are thought to go undiagnosed, so the actual number may be larger. […] Recognition of PBA is challenging since many physicians are unaware of the criteria for diagnosis. The patients emotional response may be noted by healthcare professionals as disproportionate to the situation and can be wrongly attributed to poor coping, depression, or changes to the patients baseline neurocognitive disease and, therefore, may not be addressed.

• #5 About PBA | PBAinfo

  https://www.pbainfo.org/about-pba

  PBA is a condition that causes uncontrollable crying and/or laughing that happens suddenly and frequently. […] A person having a crying episode may cry when they dont feel sad or when they only feel a little bit sad. […] While there are almost 2 million people in the US with neurologic conditions or traumatic brain injury who have been diagnosed with PBA, over 7 million people in the US with these primary conditions have symptoms that may suggest PBA. […] According to a survey of 590 TBI patients (or their caregivers), 52% have symptoms that may be PBA. […] According to a survey of 757 stroke patients (or their caregivers), 38% have symptoms that may suggest PBA. […] According to a survey of 1215 MS patients (or their caregivers), 46% have symptoms that may suggest PBA. […] According to a survey of 1799 Alzheimer’s/dementia patients (or their caregivers), 29% have symptoms that may suggest PBA.

• #5 About PBA | PBAinfo

  https://www.pbainfo.org/about-pba

  According to a survey of 125 ALS patients (or their caregivers), 45% have symptoms that may suggest PBA. […] According to a survey of 804 Parkinson’s patients (or their caregivers), 26% have symptoms that may suggest PBA. […] The presence of PBA symptoms was defined as a CNS-LS score 13 and a more restrictive definition was also evaluated using CNS-LS 21. […] PBA is neurologic, which means its caused by damage to the nervous system. […] It’s possible to have PBA and depression at the same time, but the two are separate conditions that should be diagnosed and managed separately. […] PBA occurs in the context of a neurologic condition/injury affecting the brain and is not explained by other causes such as medication use.

• #6 Pseudobulbar Affect Versus Depression: Issues in Diagnosis and Treatment

  https://www.psychiatrictimes.com/view/pseudobulbar-affect-versus-depression-issues-diagnosis-and-treatment

  Pseudobulbar affect (PBA) is a neurologic condition that is characterized by brief episodes of uncontrollable, sudden, and inappropriate emotions. The syndrome consists of uncontrollable crying or laughing, which usually is incongruent with the patients mood. […] Pseudobulbar affect was diagnosed and Mr. A was started on a new treatment regimen. The symptoms decreased in frequency and intensity. […] The exact cause of PBA is unknown. It is estimated that approximately 1.8 to 7.1 million individuals are affected in the US. […] PBA is characterized by a lack of voluntary control over affective expression, a disorder of disinhibition. Major depression is thought to involve numerous and wide spread neural pathways, but PBA may involve more specific networks that determine the motor control of affect expression.

• #6 Pseudobulbar Affect Versus Depression: Issues in Diagnosis and Treatment

  https://www.psychiatrictimes.com/view/pseudobulbar-affect-versus-depression-issues-diagnosis-and-treatment

  The diagnosis of pseudobulbar affect is made upon clinical presentation and patient self-report of symptoms. The following are key diagnostic criteria: involuntary episodes of laughing and/or crying that are sudden, unpredictable, excessive, and exaggerated. […] PBA symptoms last seconds to minutes, but major depression lasts weeks to months. Patients with PBA will describe sudden, brief, intense, and uncontrollable displays of emotion. […] There is no cure for PBA, but treatment can reduce the intensity and frequency of symptoms with the goal of improving well-being.

• #7 What is the Pseudobulbar Affect? | Neuropsychology Program | Barrow Neurological InstituteSecond Opinion IconSecond Opinion IconGroup 12

  https://www.barrowneuro.org/condition/pseudobulbar-affect/

  Pseudobulbar affect (PBA) describes a disorder that causes a person to experience uncontrollable episodes of crying, laughing, or other emotional displays that are out of context in their social interactions. […] The primary sign of pseudobulbar affect is having uncontrollable outbursts of laughing or crying in situations other people do not find funny or sad. You may also switch from crying to laughing for no apparent reason. Episodes can occur at any time. […] Symptoms of pseudobulbar affect can cause anxiety, embarrassment, and social isolation. […] Currently, it is estimated that between two million and seven million people in the U.S. have experienced symptoms consistent with pseudobulbar affect. […] Pseudobulbar affect typically occurs secondary to a neurological injury or disease, such as: Alzheimer’s disease, Amyotrophic lateral sclerosis (ALS), Brain tumors, Dementia, Multiple sclerosis, Stroke, Parkinson’s disease, Traumatic brain injury (TBI). […] Pseudobulbar affect may also occur in people who suffer a physiological disorder such as Graves disease, hyperthyroidism, or hypothyroidism.

• #8 Pseudobulbar Affect (PBA): Symptoms, Causes, & Treatment

  https://www.webmd.com/brain/pseudobulbar-affect

  Pseudobulbar affect (PBA) is a nervous system disorder that can make you laugh, cry, or become angry without being able to control when it happens. […] If you or someone you love has PBA, you might notice: Sudden, intense fits of uncontrollable crying or laughter, Crying or laughter that doesn’t seem right for the situation, Outbursts of frustration and anger, Facial expressions that don’t match emotions. […] The outbursts can happen several times a day or many times a month. […] Symptoms aren’t linked to mood. In other words, you may feel happy but start crying and cannot stop. Or you could feel sad but start to laugh when you shouldn’t. You might just cry or laugh a lot. Some people say the symptoms come on so quickly that it looks like a seizure. It’s easy to mistake the symptoms for those of depression or bipolar disorder.

• #9 6 Pseudobulbar Affect Symptoms: Intense Emotions and More

  https://www.healthline.com/health/neurological-health/pba-signs

  People who have a brain injury or neurological disease can also develop pseudobulbar affect (PBA), which causes sudden, uncontrollable, and exaggerated emotional outbursts. If the person you care for suddenly begins to laugh or cry without reason or cannot stop their emotional outbursts, they likely have PBA. […] The duration of symptoms can help you distinguish PBA from depression. Crying that’s caused by PBA lasts a few minutes at a time. With depression, symptoms can last for many weeks or months. […] PBA can pop up suddenly and unexpectedly in almost any type of situation. A person might be completely calm one second and then suddenly tear up or burst into laughter for no obvious reason. […] Most of us have experienced a fit of the giggles in which we could not stop laughing, no matter how hard we tried. People with PBA feel this way whenever they laugh or cry. No matter what they do, they cannot stop the emotional outpouring. […] Emotions can switch from one extreme to the other in people with PBA. Laughter can quickly turn to tears, and vice versa.

• #10 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  People who have pseudobulbar affect have sudden, frequent, and uncontrollable episodes of laughing or crying. In most cases, the laughing or crying is disproportionate to the humor or sadness of the situation. […] In people with PBA, there is a disparity between a persons feelings and the outward emotions they are displaying. […] The hallmark symptom of PBA is episodes lasting seconds or minutes of either tearfulness and crying or laughing that sometimes is spontaneous or clearly out of proportion to whats going on in the situation. […] People with PBA demonstrate sudden, involuntary emotional outbursts that are either incompatible to a given situation for example, laughing when told something that is sad or compatible with the situation at hand but of greater intensity than would be expected, such as laughing uncontrollably when others would typically only smile.

• #10 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  The long-term outlook for pseudobulbar affect depends on the underlying condition that the person has. Most people diagnosed with PBA have another condition such as Alzheimers disease, multiple sclerosis, or Parkinsons disease. […] There isnt a cure for PBA. The underlying conditions that accompany PBA currently dont have a cure either, and so it is a lifelong condition. Symptoms can be managed with medication and behavior modifications. […] With treatment, some people can reduce the severity and frequency of their episodes of laughing or crying.

• #11 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is characterized by brief, intense, uncontrollable episodes of crying or laughing. […] The symptoms of PBA can be severe, with persistent and unremitting episodes. […] The onset can be sudden and unpredictable, and has been described by some patients as coming on like a seizure. […] The outbursts have a typical duration of a few seconds to several minutes. […] The outbursts may happen several times a day. […] PBA is generally associated with later stages of the disease (chronic progressive phase). […] PBA in MS patients is associated with more severe intellectual deterioration, physical disability, and neurological disability. […] A study designed specifically to survey for prevalence found that 49% of patients with amyotrophic lateral sclerosis (ALS) also had PBA. […] PBA occurred in patients with more severe head injury, and coincided with other neurological features suggestive of pseudobulbar palsy.

• #11 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  The Brain Injury Association of America (BIAA) indicates that approximately 80% of survey respondents experience symptoms of PBA. […] Results from a recent investigation estimate the prevalence of PBA associated with traumatic brain injury to exceed more than 55% of survivors. […] The clinical effect of PBA can be severe, with unremitting and persistent symptoms that can be disabling to patients, and may significantly affect quality of life for caregivers.

• #12 Pseudobulbar affect: Symptoms, tests, and treatment

  https://www.medicalnewstoday.com/articles/pseudobulbar-affect

  Pseudobulbar affect (PBA) involves brief, uncontrolled episodes of crying or laughing. […] PBA can affect a persons relationships, work, and quality of life. […] PBA causes sudden, short emotional reactions that may include crying, laughing, or a mixture of both. Episodes can last several seconds to several minutes. […] People with PBA symptoms may find these episodes embarrassing, confusing, and frustrating. The condition can affect a persons work, relationships, and quality of life. […] PBA is not a condition in its own right, so the outlook depends on what is causing it. For example, the outlook for people with a progressive neurological condition, such as ALS, will differ from those who have had a stroke. […] That said, PBA alone can significantly affect a persons work, social life, and mental health.

• #13 Pseudobulbar Affect (PBA) – Brain Injury Association of America

  https://biausa.org/brain-injury/about-brain-injury/psuedobulbar-affect-information

  Pseudobulbar affect (PBA) is a neurological condition involving involuntary, sudden, and frequent episodes of laughing or crying. It occurs secondary to neurological disease – meaning that PBA is caused by another disorder – and is most commonly found in patients with: […] PBA episodes, which often involve uncontrollable laughter or involuntary crying, are unpredictable. They can occur any time and last several seconds or minutes. […] Symptoms can range from mildly disturbing to seizure-like episodes.

• #14 Pseudobulbar affect: When patients laugh or cry, but don’t know why | MDedge

  https://blogs.the-hospitalist.org/content/pseudobulbar-affect-when-patients-laugh-or-cry-dont-know-why

  Pseudobulbar affect (PBA) is a disorder of affective expression that manifests as stereotyped and frequent outbursts of crying (not limited to lacrimation) or laughter. Symptoms are involuntary, uncontrolled, and exaggerated or incongruent with current mood. Episodes, lasting a few seconds to several minutes, may be unprovoked or occur in response to a mild stimulus, and patients typically display a normal affect between episodes. […] PBA has been most commonly described in 6 major neurologic disorders: Alzheimers disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinsons disease, stroke, and traumatic brain injury (TBI). […] Of these disorders, most studies have found the highest PBA prevalence in patients with ALS and TBI, with lesser (although significant) prevalence in Parkinsons disease.

• #15 Recognizing Signs & Symptoms – PBA Voices

  https://pbavoices.org/understanding-pba/recognizing-signs-symptoms/

  More accurate and timely diagnosis and treatment are possible as awareness of PBA increases. […] Frequent, involuntary, and uncontrollable outbursts of crying or laughing that don’t seem appropriate to a given situation. […] Outbursts of frustration and anger. […] Facial expressions that don’t match emotions. […] A “normal” mood between episodes.

• #15 Recognizing Signs & Symptoms – PBA Voices

  https://pbavoices.org/understanding-pba/recognizing-signs-symptoms/

  Feeling overwhelmed, stressed, or anxious is a normal response to the challenges of life, especially when living with a brain injury or other neurological disorder. As PBA can mimic other conditions, it can be difficult to diagnose. That is why it is frequently mistaken for depression. […] The Center for Neurologic Study-Lability Scale (CNS-LS) is a short questionnaire that can help individuals with neurologic illness or injury identify the presence of PBA symptoms and their frequency. A CNS-LS score of 13 or higher may suggest PBA, but low and high scores can occur in persons with and without PBA. […] Similarly, keeping a detailed journal is helpful when talking with health care providers about PBA symptoms. Keeping track of episodes is important to assist in communicating with your healthcare provider.

• #16 Pseudobulbar Affect: Signs, Symptoms, and Treatment for Uncontrollable Laughing or Crying – Neurology Advisor

  https://www.neurologyadvisor.com/features/pseudobulbar-affect-signs-symptoms-and-treatment-for-uncontrollable-laughing-or-crying/

  Pseudobulbar affect is characterized by sudden, frequent, uncontrollable outbursts of crying and/or laughing that may be disproportionate or inappropriate to the social context. […] Although patients may experience uncontrollable crying, laughing, or both, the former appears to be a more common manifestation of PBA. […] The degree of the emotional response by the patient is often striking, with the crying or laughter persisting for a considerable period of time and unable to be suppressed by the patient. […] Patients with PBA often sob uncontrollably for seemingly no reason while verbalizing that they are not sad. […] These uncontrollable episodes of crying or laughter come with a great deal of social anxiety. […] Patients with PBA have no control over when these outbursts will occur or how long they will last. […] The goal of treatment of PBA is to diminish the severity and frequency of episodes. […] The number of individuals with neurologic conditions is substantial, and many of these also experience PBA, which can cause emotional distress due to social anxiety, embarrassment, and social isolation.

• #17 Raising Awareness of Pseudobulbar Affect: Knowing the Signs, Symptoms, and Treatment for Patients With Uncontrollable Laughing or Crying – Clinical Advisor

  https://www.clinicaladvisor.com/features/raising-awareness-of-pseudobulbar-affect-knowing-the-signs-symptoms-and-treatment-for-patients-with-uncontrollable-laughing-or-crying/

  Pseudobulbar affect is characterized by sudden, frequent, uncontrollable outbursts of crying and/or laughing that may be disproportionate or inappropriate to the social context. […] Although patients may experience uncontrollable crying, laughing, or both, the former appears to be a more common manifestation of PBA. […] The degree of the emotional response by the patient is often striking, with the crying or laughter persisting for a considerable period of time and unable to be suppressed by the patient. […] In addition, laughing and crying by the patient may occur in situations that are not perceived by others as being sad or funny. […] As inconsolable episodes of crying are frequent with PBA, this disorder is often misdiagnosed as depression. […] To differentiate between PBA and depression, it is valuable to determine the duration of the crying episodes in order to distinguish PBA from depression.

• #17 Raising Awareness of Pseudobulbar Affect: Knowing the Signs, Symptoms, and Treatment for Patients With Uncontrollable Laughing or Crying – Clinical Advisor

  https://www.clinicaladvisor.com/features/raising-awareness-of-pseudobulbar-affect-knowing-the-signs-symptoms-and-treatment-for-patients-with-uncontrollable-laughing-or-crying/

  Episodes of crying with depression are often longer in duration than the episodes of pathologic crying characteristic of PBA. […] Both the exaggerated emotional response and the discordance between mood and emotional display are additional characteristics of PBA that are not expected with depression. […] Patients with PBA often sob uncontrollably for seemingly no reason while verbalizing that they are not sad.

• #18 Pseudobulbar Affect (PBA) | American Stroke Association

  https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects/pseudobulbar-affect

  Because people with PBA may cry a lot, their symptoms are often confused with depression. But PBA is not depression. In the past, PBA has been treated with anti-depressants, although they may only be moderately successful. […] Ongoing research into stroke, traumatic brain injury, multiple sclerosis, Alzheimer’s disease and ALS continues to increase our knowledge about PBA.

• #19 Pseudobulbar Affect – Causes, Symptoms and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/pseudobulbar-affect-causes-symptoms-and-treatment

  Among most of the patients that suffer from PBA, intense crying is more common than laughing, which often leads to misdiagnosis of depression. […] Pseudobulbar affect is observed among people that already suffer from some other form of neurological disorder. It is relatively difficult to diagnose and often goes unchecked and unreported due to lack of awareness. […] Due to the stigma, lack of awareness, and similarities with neurological disorders, patients of PBA are often misdiagnosed/undiagnosed. Their quality of life, social interactions, productivity, and routine are drastically affected by PBA. […] Seeking medical consultation from neurologists can help you reduce the symptoms and their frequency. […] Uncontrollable bouts of laughter or crying may indicate symptoms of PBA. Seeking therapy, medical consultation, treatment, and medication will relieve the symptoms.

• #20 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  Pseudobulbar affect can be mistaken for depression, because it often involves crying. However, typically depression lasts longer than PBA outbursts, which are usually fairly brief lasting for several minutes. […] The exact cause of PBA is unclear but it is thought to be due to a combination of damage to the central nervous system in the areas of the brain that are involved with controlling your emotions and the effect this has on how signals are carried between nerve cells by neurotransmitters chemicals which allow the cells to communicate with one another. […] It is thought that the area of the brain known as the cerebellum may have a key role in regulating emotional responses and keeping them proportional to the situation. […] Estimates of how many people with MS are affected by PBA vary widely ranging from 7% to 95% depending on the terminology used, the diagnostic criteria and the population of people being studied.

• #20 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  The first criteria to be used to diagnose PBA was developed by Poeck in 1969 and defined four criteria that must be met: the emotional response is situationally inappropriate, the patients feelings and the affective response are not closely related, the duration and severity of the episodes cannot be controlled by the patient, expression of the emotion doesn’t lead to a feeling of relief. […] A more recent set of criteria were developed in 2006 by Cummings. […] The aim of treatment for PBA is to reduce the frequency and severity of episodes. […] The mainstay of treatment has been the 'off-label’ use of antidepressants which target the neurotransmitters noradrenaline, serotonin and glutamate. […] In 2013, the European Medicine Agency (EMA) licensed a new combination drug called Nuedexta for treating pseudobulbar affect in MS and other neurological conditions, including MND. […] It is thought that Nuedexta takes longer to have an effect on pseudobulbar affect than antidepressants, taking up to four to five weeks to work.

• #21

• #22 About PBA | Nuedexta

  https://www.nuedexta.com/about-pba

  The uncontrolled nature of PBA can be upsetting, uncomfortable, and embarrassing for the patient experiencing it. […] It is important to understand that PBA is a neurologic condition, not a psychiatric condition like depression, although PBA symptoms can be similar. […] PBA is thought to affect about 1.8 million people in the US who suffer from certain neurologic conditions or brain injury. […] Some patients who have had a traumatic brain injury may develop symptoms of uncontrollable crying and/or laughing very soon after their injury. […] Stroke survivors can experience emotional and behavioral changes during their recovery that can make it difficult to identify PBA symptoms as a separate condition. […] Multiple sclerosis patients may experience a disruption in nerve transmissions throughout the body, producing a wide variety of symptoms that can be unpredictable and require different medications to treat them.

• #22 About PBA | Nuedexta

  https://www.nuedexta.com/about-pba

  Alzheimer disease and other dementias can make PBA especially hard to spot, since sudden episodes of crying and/or laughing can be mistaken for depression or other personality changes associated with dementia. […] While the main symptom of amyotrophic lateral sclerosis is gradual loss of motor movement, secondary symptoms can occur, including uncontrollable crying and/or laughing. […] Parkinsons disease is a progressive condition known for its physical symptoms, but it also affects areas of the brain that control emotional expression. […] The uncontrollable crying and/or laughing episodes of PBA may be a result of brain damage caused by neurologic conditions or brain injuries. […] Damage to the cerebellum, from a neurological condition or brain injury, may lead to miscommunication with the cerebral cortex. This miscommunication is thought to result in PBA episodes.

• #23 Pseudobulbar Palsy: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/pseudobulbar-palsy

  Pseudobulbar palsy is a collection of symptoms, like difficulty swallowing and speaking, that develop alongside various causes of brain damage. […] The main features of pseudobulbar palsy are difficulty speaking, difficulty swallowing and rapid, dramatic changes in mood. […] This can involve symptoms like: Outbursts of uncontrolled or inappropriate laughing or crying. […] About 85% of children with pseudobulbar palsy experience cognitive impairment and seizures. […] The prognosis (outlook) for people with pseudobulbar palsy depends greatly on the underlying cause. […] On the other hand, pseudobulbar palsy typically doesn’t improve in cases of chronic degenerative conditions, like MS, Parkinson’s disease and ALS. […] Pseudobulbar palsy can lead to the following complications: Aspiration pneumonia: Difficulty controlling your tongue and mouth muscles may lead to inhaling bits of food or liquids, which can cause aspiration pneumonia. […] Severe dysphagia can make it nearly impossible to swallow foods and liquids. This can lead to malnutrition and dehydration. […] Pseudobulbar palsy isn’t directly fatal. But many of the underlying conditions that cause it (like stroke and ALS) can be.

• #24 What Is Pseudobulbar Affect?

  https://www.brainandlife.org/articles/what-is-pseudobulbar-affect

  Pseudobulbar affect (PBA) a condition that causes excessive and uncontrollable crying or laughing unrelated to either sadness or happiness can occur with many neurologic conditions, including Alzheimer’s disease and dementia, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, stroke, and traumatic brain injury. […] People may develop PBA when parts of the brain and brain stem that control movement have been damaged on both sides of their brains. […] The condition may occur early or late in the underlying disease’s course and is sometimes misdiagnosed as depression or bipolar disorder. […] While not life-threatening, PBA can make people anxious, embarrassed, or withdrawn if they fear having an outburst in social situations. Having PBA doesn’t mean the underlying neurologic condition is progressing or that other symptoms will appear.

• #25 Pseudobulbar Affect in Parkinsonian Disorders: A Review

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.18051

  Pseudobulbar affect (PBA) is a neurological symptom of inappropriate and uncontrollable laughter or crying that occurs secondary to a variety of neurological conditions, including parkinsonian disorders. […] PBA is a socially and emotionally debilitating symptom that has been estimated to affect 3.6% to 42.5% of the population with Parkinson’s disease. […] The suggested pathophysiology is also in accordance with the increased prevalence of PBA reported in atypical parkinsonian disorders, such as progressive supranuclear palsy (PSP) and the cerebellar type of multiple system atrophy (MSA-C). […] PBA prevalence rates in patients with PD have been shown to range from 3.6% to 43%, and this high variability is in part secondary to differences in indexing measures and thresholds used. […] Furthermore, some studies have found that PBA prevalence increases with disease progression.

• #26 Pseudobulbar Affect in Parkinsonian Disorders: A Review

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.18051

  PD patients with more advanced disease have been demonstrated to exhibit an increased prevalence of PBA, while younger PD patients have been shown to exhibit greater PBA symptom severity. […] PBA has also been associated with changes in living status, i.e., being moved to supervised living and to reduced caregiver work productivity. […] While the symptoms of PBA may appear physically harmless, they can be emotionally taxing and have a significant negative impact on the patient and caregiver QoL and on social and occupational functioning. […] Despite its relatively high prevalence in patients with neurological diseases, the recognition and diagnosis of PBA in the community remains subpar. […] The treatment agents currently available for PBA are described below. […] The only support for the use of such medications in patients with parkinsonian disorders comes from case reports in PD patients with PBA secondary to STN-DBS or thalamotomy and in patients with MSA-C. […] PBA is a distressing neurological condition that is relatively common but underappreciated in the parkinsonian population.

• #27 Pseudobulbar affect: When patients laugh or cry, but don’t know why | MDedge

  https://blogs.the-hospitalist.org/content/pseudobulbar-affect-when-patients-laugh-or-cry-dont-know-why

  As PBA has become better defined and more widely recognized, additional sequelae have been described. PBAs sporadic and unpredictable nature and the potential embarrassment and distress of public outbursts may lead to an agoraphobia-like response. […] People with PBA report a significantly worse subjective assessment of general health, quality of life, relationships, and work productivity compared with people with similar primary underlying diagnoses without PBA. […] Lesions of the volitional pathway have been correlated with conditions of PBA, whereas direct activation of the emotional pathway tended to lead to emotional lability or the crying and laughing behaviors observed in dacrystic or gelastic epilepsy. […] PBA as a disease state likely has been widely under-reported, under-recognized, and misdiagnosed (typically, as a primary mood disorder).

• #28

  https://msfocusmagazine.org/Magazine/Magazine-Items/Posted/Reining-in-Pseudobulbar-Affect

  For many people and families dealing with PBA, the disorder’s symptoms can be stressful and embarrassing enough to cause withdrawal from social situations. […] By reducing the frequency and severity of emotional episodes, you may discover a renewed interest in social activities and the desire to participate.

• #29 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  Pseudobulbar affect (PBA) may occur in association with a variety of neurological diseases, and so may be encountered in the setting of amyotrophic lateral sclerosis, extrapyramidal and cerebellar disorders, multiple sclerosis, traumatic brain injury, Alzheimers disease, stroke, and brain tumors. […] PBA may be encountered in the setting of amyotrophic lateral sclerosis (ALS), extrapyramidal and cerebellar disorders (Parkinsons disease, multiple system atrophy, progressive supranuclear palsy), multiple sclerosis (MS), traumatic brain injury, Alzheimers disease and other dementias, stroke, and brain tumors. […] PBA has also been noted to interfere with rehabilitation; a report of patients with locked-in syndrome and PBA revealed that PBA interfered with evaluation and treatment of swallowing dysfunction, the effective use of any remaining motor ability, and with attempted communication by the patient.

• #30 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  Patients with pseudobulbar affect (PBA) experience episodes of involuntary and uncontrollable crying and/or laughing outside of socially appropriate circumstances. PBA has also been referred to as emotionalism, emotional lability, or pathological crying and laughing, particularly when attributed to stroke or traumatic brain injury (TBI). The primary neurotransmitters involved in PBA are serotonin and glutamate, and pharmacologic treatments have focused on drugs that modulate these neurotransmitters. Current prevailing theories suggest that PBA occurs when neural pathways that modulate emotional responses in the brain are interrupted, particularly descending pathways from the brain (such as the frontal lobes) to the cerebellum. Medical disorders or conditions, such as Parkinson disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer disease (AD), TBI, and stroke, which result in a disruption of those pathways, can produce the hallmark symptoms of PBA – involuntary and uncontrollable laughter and/or crying.

• #30 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  PBA is an underrecognized and undertreated condition that affects upwards of 2 million individuals in the United States. Treatment options include the off-label use of centrally acting drugs, such as antidepressants, and the FDA-approved drug combination of dextromethorphan and quinidine. The time to observable alleviation of PBA symptoms may also be shorter compared with alleviation of depressive symptoms by TCAs. The efficacy of dextromethorphan/quinidine in the treatment of PBA has been supported by double-blind clinical studies. […] Longer-term safety of dextromethorphan/quinidine treatment of PBA was investigated in an open-label, 52-week, multicenter study. The most frequent AEs during treatment were nausea (24.8%), headache (22.8%), dizziness (19.5%), falls (16.5%), diarrhea (16.3%), fatigue (14.6%), and weakness (13.7%). These long-term AEs are consistent with results observed in placebo-controlled trials.

• #30 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  Patients with PBA may be more prone to depression, with a corresponding propensity to take antidepressants at a higher rate compared with cohorts without PBA. Education is essential to the clinical management of this condition. Patients and family members must be educated about the general nature of PBA, and pharmacists are in a good position to educate patients and family members about expectations for duration of treatment.

• #31 Introduction to Pseudobulbar Affect: Setting the Stage for Recognition and Familiarity With This Challenging Disorder

  https://www.ajmc.com/view/introduction-to-pseudobulbar-affect-setting-the-stage-for-recognition-and-familiarity-with-this-challenging-disorder

  Pseudobulbar affect (PBA), despite its prevalence and distinctive symptoms, is widely underrecognized and undertreated. […] Symptoms suggestive of PBA commonly occur in individuals diagnosed with Parkinson disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer disease (AD), traumatic brain injury (TBI), and stroke. […] PBA occurs most commonly among patients who have PD, multiple sclerosis, amyotrophic lateral sclerosis or AD or have experienced a traumatic brain injury, stroke and other neurological diseases that damage the central nervous system. […] According to the PRISM trial results, approximately 46% of patients diagnosed with MS have symptoms suggestive of PBA. […] According to the PRISM trial results, roughly 45% of patients diagnosed with ALS also have symptoms suggestive of PBA.

• #31 Introduction to Pseudobulbar Affect: Setting the Stage for Recognition and Familiarity With This Challenging Disorder

  https://www.ajmc.com/view/introduction-to-pseudobulbar-affect-setting-the-stage-for-recognition-and-familiarity-with-this-challenging-disorder

  According to the PRISM trial results, roughly 30% of patients diagnosed with AD also have symptoms suggestive of PBA. […] According to the PRISM trial results, roughly 53% and 38% of patients diagnosed with these conditions, respectively, have symptoms suggestive of PBA. […] Symptoms suggestive of PBA in nursing homes present in 17.5% of residents with neurological conditions and 9% of residents overall. […] Frequently co-occurring psychiatric disorders, especially depression (35%), can present with symptoms similar to PBA. […] Patients with PBA are aware of social norms and the inappropriateness of their responses. Thus, they are embarrassed by the inability to control these involuntary outbursts. […] Patients with PBA experience episodes of spontaneous or exaggerated laughter and/or crying that are disproportionate to or inappropriate for the current situation.

• #32 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  Pseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. […] The occurrence of PBA symptoms thus appears to be determined largely by the anatomic location of brain lesions, independent of the underlying condition. […] More than one third of patients (n=1944; 36.7%) had a CNS-LS score 13, suggesting PBA symptoms. […] Higher CNS-LS scores were associated with impaired QOL and greater use of antipsychotic/antidepressant medications. […] Data from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions. […] The proportion of patients with CNS-LS 13 among each neurological condition was lowest for those with PD (26.0%) and highest for those with TBI (52.4%).

• #33 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  The finding that patients with a CNS-LS 13 rated their neurological condition as having a greater negative impact on their QOL is interesting and parallels the findings from a burden of illness (BOI) study conducted as a follow-on to the online HPOL prevalence study discussed above. […] The presence of inappropriate laughing and crying has been consistently associated with negative health status. […] Psychotropic medication use was also significantly higher in patients with CNS-LS 13 versus CNS-LS 13. […] The PRISM registry is the largest study to date to assess PBA symptom prevalence in a clinical setting across a variety of neurological conditions.

• #34 Pseudobulbar Affect (PBA) After a Stroke – Amplify Speech Therapy

  https://www.amplifyspeechtherapy.com/post/pseudobulbar-affect-after-stroke

  PBA is when your emotions act a little wild and don’t match what’s happening. For example, you might burst into laughter during a serious conversation, or tears might flow even when you’re not sad. […] It’s more common after a stroke or other brain injuries. And more people experience tears than do laughter. […] PBA occurs in 1 of 5 stroke survivors according to one study. […] If you’ve had a stroke and wonder if you have PBA, here are some signs: 1. Inappropriate Laughter or Crying: You laugh or cry when it doesn’t fit the situation. 2. No Connection to Feelings: Your emotions don’t match how you really feel. 3. Happens Often: These emotions pop up more often than before. […] For most people who experience PBA, the heightened emotional episodes do lessen with time.

• #35 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  Unfortunately, PBA has often been missed by clinicians. The survey by Work and colleagues indicated that, among patients who discussed their crying/laughing symptoms with a physician, 41% received a diagnosis, but none received a diagnosis of PBA. […] The exact causes of PBA are unclear, although it is believed to be related to disruption of neural networks involving the limbic and paralimbic systems modulated by the cerebellum. PBA is believed to be a disorder of frontal dysregulation and disinhibition. […] PBA can be confusing to the patient, family members, and social contacts because the behavior does not necessarily reflect how the affected person is actually feeling. PBA sometimes occurs as an exaggerated response to a predictable (and expected) emotion, but it also can occur as a completely paradoxical response to the circumstances.

• #36 Pseudobulbar Affect | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117649/all/Pseudobulbar_Affect

  The consequence of underlying neurologic damage. […] Estimated prevalence across patients with these disorders is ~10%, although it may reach as high as 38%. […] PBA is believed to result from dysfunction anywhere along this circuit from cortex through basis pontis to cerebellum, disrupting coordination of mood and behavioral output and causing disinhibition of emotional motor expression. […] Disruption of glutamate and serotonin systems are thought to be central to PBA.

• #37 Diagnosing PBA: Three steps to help assess PBA

  https://www.nuedextahcp.com/diagnosing-pba

  Pseudobulbar Affect (PBA) can only be diagnosed following a complete assessment by a qualified healthcare provider. […] A CNS-LS score of 13 may suggest PBA symptoms, and a score of 21 may suggest more severe and frequent PBA symptoms. […] PBA occurs secondary to a variety of otherwise unrelated neurologic conditions, and is characterized by involuntary, sudden, and frequent episodes of laughing and/or crying. PBA episodes typically occur out of proportion or incongruent to the underlying emotional state. PBA is a specific condition, distinct from other types of emotional lability that may occur in patients with neurologic disease or injury.

• #38 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. […] PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. […] The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. […] Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta) is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. […] Living with pseudobulbar affect (PBA) can be embarrassing and stressful. […] Do you experience emotional responses that are sometimes exaggerated or inappropriate? […] Do your emotional outbursts reflect what you’re feeling at the time?

• #39 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  The goals of pharmacotherapy are to reduce both the severity and frequency of PBA episodes. The most commonly used treatments target the primary neurotransmitters implicated in PBA, serotonin and glutamate. […] In small trials and case studies with poststroke, ALS, MS, and brain-injury patients, the SSRIs that have shown a reduction in PBA-episode frequency and severity include escitalopram, fluvoxamine, citalopram, fluoxetine, and paroxetine. […] The only FDA-approved product for PBA, Nuedexta, is a fixed-dose combination of dextromethorphan hydrobromide/quinidine sulfate (DHQ). […] PBA is a type of affect lability characterized by sudden, frequent, and uncontrollable episodes of crying and/or laughing, often associated with AD, ALS, MS, PD, stroke, and TBI. Treatments for PBA target serotonin, norepinephrine, and glutamate to reduce severity and episode frequency.

• #40 Treatment for Pseudobulbar Affect

  https://resources.healthgrades.com/right-care/brain-and-nerves/understanding-treatment-options-for-pseudobulbar-affect

  The treatment goals for PBA include reducing the frequency and severity of emotional outbursts. […] Currently, Nuedexta is the only medication with approval from the Food and Drug Administration (FDA) to treat PBA. […] Studies of the drug found that it reduced symptoms and helped people have more days without episodes of PBA. […] Although PBA and depression are different conditions, antidepressants can be effective for managing PBA. […] In general, doctors save third-line treatments as an additional option for people whose symptoms are not improving or when first- and second-line medications are causing severe side effects.

• #41 Create a healing environment for patients with pseudobulbar affect

  https://www.myamericannurse.com/healing-environment-pseudobulbar-affect/

  PBA treatment includes coping strategies and pharmacologic management. […] If nonpharmacologic interventions dont work, patients may need to turn to medication, such as antidepressants or dextromethorphan and quinidine. […] PBA affects patients physically, socially, and emotionally. Increasing awareness and providing patients and families with ways to manage the disorder are the first steps to creating a healing environment that supports patients in their efforts to overcome the effects of PBA.

• #42 Pseudobulbar Affect: Causes, Diagnosis, and Coping Strategies

  https://www.psychologs.com/understanding-the-pseudobulbar-affect-causes-diagnosis-and-coping-strategies/?srsltid=AfmBOopZ7Fz5Ae-9hmZsuPMCi2QvA1vpL1y1gzVrKVC0j3CxSR1YTFqi

  This affect become more common among people with dementia and Multiple sclerosis (MS) but it can affect anyone who has neurological conditions. […] Whenever diagnosing the PBA it is important to look for the frequency and intensity of the laughing and crying episodes. […] Patients with PBA may have difficulty in building social relationships with others. […] Medication is one of the ways to treat pseudobulbar affect. […] Antidepressants like Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are prescribed for patients of PBA. […] Another treatment for pseudobulbar affect is cognitive behavioral therapy. […] By adopting coping strategies, one can manage the pseudobulbar effect in a manageable way. […] Relaxation and deep breathing techniques play a significant role as coping strategies against pseudobulbar affect.

• #43 Pseudobulbar Affect in Patients with Multiple Sclerosis: A Systematic Review

  https://www.mdpi.com/2813-3064/2/3/13

  Pseudobulbar affect (PBA), also referred to as pathological laughing and crying, is an under-recognized and under-treated co-morbidity. […] The clinical presentation was found to be comparable to that of PBA in the context of other neurological disorders, as it reflected the location of underlying lesions (especially in the brainstem) rather than the associated pathology. […] PBA might be more commonly associated with advanced stages of the chronic progressive form of MS, and appears to be linked with severe disability. […] The emotional incontinence that characterizes PBA is often perceived as ego-dystonic by the patient and can cause significant social embarrassment, as well as frustrated urges to voluntarily control it. […] The studies that assessed the relationship between PBA and the course of MS found conflicting results: in the study by Feinstein at al., 91% of patients with PBA had chronic progressive MS, whereas in the study by Hanna et al., 74% of patients were affected by relapsing-remitting MS.

• #43 Pseudobulbar Affect in Patients with Multiple Sclerosis: A Systematic Review

  https://www.mdpi.com/2813-3064/2/3/13

  The phenomenology of PBA in patients with MS was found to be similar to that reported by patients with PBA in the context of other neurological conditions, suggesting that the clinical manifestations are influenced by the anatomical location of the brain lesions. […] Of relevance are the results of the studies using magnetic resonance imaging in patients with PBA compared to patients without PBA. […] The reviewed studies varied in both methodological quality and level of evidence. Most studies were conducted on small samples of patients, due to the relatively low prevalence of PBA in MS and/or to difficulties in patient recruitment.

• #44 Diagnosis and Treatment of Pseudobulbar Affect

  https://www.todaysgeriatricmedicine.com/archive/MA16p30.shtml

  This finding translated to a potential prevalence of PBA of 17.5% in the predisposed population (those with neurologic disorders and without psychosis or disruptive behavior) and 9% among all nursing home residents. […] The study also found that residents with PBA symptoms were more likely to be using antipsychotics, as well as anxiolytics and antidepressants. […] Identifying and managing PBA can be challenging for clinicians because it is underrecognized and the symptoms overlap with those of depression and other psychiatric disorders. […] These findings underscore the importance of more accurate diagnosis of PBA.

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