Impairments in emotional control: Indicators, assessments, and remedies
Pseudobulbar Affect (PBA) is a neurological condition that can cause brief, involuntary episodes of crying or laughing, often without any apparent trigger. This condition is commonly associated with a range of neurological disorders that affect the brain areas responsible for emotional regulation.
Neurological Disorders Linked to PBA
The most common neurological disorders associated with PBA include Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), stroke, traumatic brain injury (TBI), and other disorders affecting upper motor neurons such as pseudobulbar palsy.
In ALS, a progressive neurodegenerative disorder affecting motor neurons, PBA can occur due to neural damage, leading to involuntary emotional outbursts. Similarly, in MS, lesions in brain regions controlling emotions can provoke PBA episodes, experienced by about 10% of people with MS.
Stroke and TBI can also result in PBA by disrupting brain pathways that regulate emotional expression. Other neurological conditions impacting upper motor neurons or brain connectivity, like pseudobulbar palsy, also share this symptom.
Managing PBA
The management of PBA focuses on symptom control. The Food and Drug Administration (FDA) approved a dextromethorphan-quinidine combination (Nuedexta) for PBA in 2010. This medication has demonstrated efficacy in reducing PBA episodes by modulating neurotransmitter activity in the brain.
Other treatments may include off-label use of antidepressants, though the combination of dextromethorphan and quinidine remains the best-supported option. Addressing the primary neurological disorder and providing supportive care (speech therapy, counseling) are also important for overall management.
Seeking Support
People with PBA and neurological conditions may benefit from seeking emotional support from a healthcare professional or support group. National organizations such as the Brain Injury Association of America, Amyotrophic Lateral Sclerosis Association, National Multiple Sclerosis Society, Parkinson's Foundation, and Alzheimer's Association can direct someone to a local or online support group.
It is important for anyone experiencing unexplained bouts of crying to speak with a doctor, as PBA alone can significantly affect a person's work, social life, and mental health. A low awareness of PBA among doctors can make it difficult for patients to get accurate information about the condition, but ongoing research and increased awareness are helping to address this issue.
[1] National Institute of Neurological Disorders and Stroke. (2021). Pseudobulbar Affect Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Pseudobulbar-Affect-Fact-Sheet
[2] National Multiple Sclerosis Society. (2021). Pseudobulbar Affect. Retrieved from https://www.nationalmssociety.org/Symptoms-Diagnosis/Symptoms/Pseudobulbar-Affect
[3] Mayo Clinic. (2021). Pseudobulbar affect. Retrieved from https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/symptoms-causes/syc-20368709
[4] American Academy of Neurology. (2020). Pharmacological treatment of pseudobulbar affect in adults. Retrieved from https://www.aan.com/guidelines/practice-parameters/post-stroke-and-post-traumatic-brain-injury-pseudobulbar-affect-pharmacological-treatment-in-adults-parameter
[5] National Institute on Aging. (2021). Pseudobulbar Affect. Retrieved from https://www.nia.nih.gov/health/pseudobulbar-affect
Neurological disorders such as Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), stroke, traumatic brain injury (TBI), and other neurological conditions affecting upper motor neurons can be linked to Pseudobulbar Affect (PBA). The management of PBA focuses on symptom control, with the Food and Drug Administration (FDA) approved dextromethorphan-quinidine combination (Nuedexta) being one treatment option. People with PBA and other neurological conditions may find support in seeking help from healthcare professionals or support groups.
