Have you heard or do you know about Pseudobulbar affect; if NO, then join me on this and lets learn together.
image source:http://www.msunites.com/wp-content/uploads/Pseudobulbar-brain-chart
Pseudobulbar affect (PBA) is a condition associated with common neurological diseases or brain injury,which affects the way the brain controls emotion and leads to episodes of sudden uncontrollable and inappropriate outbursts of laughter or crying.
PBA is not a new. In fact, it was first described in medical literature over 130 years ago by Charles Darwin.
Pseudobulbar affect often is mistaken for mood disorders, like depressionbbut it is not the same.
image source:http://www.emedmd.com/sites/default/files/Motor%20neurone%20disease%20diagram%20of%20motor%20neuron%20pathways
Causes of Pseudobulbar affect (PBA)
Pseudobulbar affect (PBA) occurs mainly in people with neurological conditions or injuries, including:
- Stroke
- Amyotrophic lateral sclerosis (ALS)
- Multiple sclerosis (MS)
- Hypothyroidism
- Traumatic brain injury
- Alzheimer's disease
- Parkinson's disease
Symptoms of Pseudobulbar affect (PBA)
- Episodes of uncontrollable laughing or crying which do not match the individual’s actual feelings (often inappropriate or unrelated to the situation at hand)
- Crying may be prolonged and difficult to stop
- Expression may be spontaneous or unmotivated
- Discussing topics with emotional content may trigger laughter or crying that is disproportionate to an appropriate level of emotion
image sourse:http://www.pbainfo.org/sites/default/files/pba-vs-depression-chart
Diagnosis of Pseudobulbar affect (PBA)
PBA can have a significant impact on relationships, social interaction and overall quality of life. Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation, but it call for concern because of its confusion with depression and other neurologic and psychiatric disorders. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists.
To helpthe doctor determine if patient have PBA, then he shares the specific details about your emotional outbursts.
Treatment of Pseudobulbar affect (PBA)
The goal of treating Pseudobulbar affect (PBA) is to diminish the severity and frequency of episodes. In that case medications includes:
Antidepressants such as Tricyclic antidepressants, Selective serotonin reuptake inhibitors, Valproate, Lithium can be uesd to reduce the emmotional part of the patient.
Nuedexta™ (A new medication recently approved by the FDA for the treatment of PBA.) making this the first FDA-approved drug for this indication. Nuedexta™ compound contains dextromethorphan 20 mg and quinidine 10 mg, thus taking advantage of the blockade exerted by quinidine on the first-pass hepatic metabolism of dextromethorphan.
References
- Lépine R, Note sur la paralysie glosso-labiée cérébrale à forme pseudo-bulbaire, Revue Mensuelle de Médecine et de Chirurgie, 1877;1:909–22.
- Wortzel HS, Oster TJ, Anderson CA, et al., Pathological laughing and crying : epidemiology, pathophysiology and treatment, CNS Drugs, 2008;22:531–45.
- http://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/treatment/txc-20198596
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849173