Multiple Sclerosis is a disease which can definitely have a great impact upon one's mood. Depression and even euphoria can be symptoms of this disease. Some people with MS may also be very emotionally volatile with great mood swings. But in addition to this emotional turbulence about ten percent of us who have Multiple Sclerosis may also have a condition known as pseudobulbar affect or PBA.
What is pseudobulbar affect?
This condition may be known by other names including "emotional incontinence" or "Involuntary Emotional Expression Disorder." Basically it means that you may have bouts of uncontrollable laughing or crying without feeling the emotions associated with your expression. You might start crying but really be feeling content. You may begin to laugh without warning and without finding anything funny. Once the person starts to cry or laugh they may find it nearly impossible to stop. Imagine how difficult this condition would be to deal with and especially in public settings.
Who gets PBA?
Generally people who have neurological disorders may be susceptible to having this condition. The populations associated with having PBA include those who have Multiple Sclerosis, amyotrophic lateral sclerosis, Alzheimer's disease, Parkinson's disease, stroke, and traumatic brain injury. It is estimated that more than one million people suffer from PBA in the United States.
How do you know if you have it?
This may be a tough question to answer. PBA can go undiagnosed as people may confuse it with a mood disorder like depression especially if the person cries a lot. Generally a psychiatrist or neurologist will be the specialists who can diagnose PBA. A self report measure called the Center for Neurologic Study-Lability Scale (CNS-LS) can be used to rate an MS patient's emotional liability and whether or not they may have PBA. If you find that you are crying or laughing in situations inappropriate for such expressions or if your tears or laughter do not match your underlying mood then it may be wise to seek help from your doctor or neurologist.
What causes PBA?
There are many complex neurological theories about what brain functions go awry to cause this condition. One of the older theories proposed was that there was damage to the nerves passing through the medulla oblongata (located in the brainstem). Newer hypotheses postulate that PBA is caused by lesions in the limbic system which is involved with emotional feeling and expression of mood. Another focus of research has been to look at whether lesions in the frontal lobe can cause PBA. No one theory has been proven yet by scientific study.
What can be done to treat PBA?
Right now there is no FDA approved medication to specially treat PBA. The National MS Society tells us that some antidepressants may be helpful in decreasing the symptoms of PBA. The medications which have been used in some clinical trials and was found to be beneficial in treating PBA include: Amitriptyline. levodopa, desipramine, fluoxetine, and fluvoxamine. Randolph Schiffer, M.D. and Laura E. Pope, Ph.D. in their article entitled, "Review of Pseudobulbar Affect Including a Novel and Potential Therapy" suggest that a low dose of any of these antidepressants may be effective in treating PBA and that the therapeutic response to such treatment may only take as little as several days. Avanir pharmaceuticals is looking into further studies of a medication called Zenvia, which is taken orally. This medication consists of a combination of dextromethorphan and quinidine. The FDA is requiring more studies be done before they would approve this drug in the United States.
If you suspect that you or a loved one has Pseudobulbar Affect it is a good first step to consult with a neurologist so that it can be correctly identified and diagnosed. You will want to educate others to the fact that you have this condition which can cause you to express emotions in inappropriate situations. Let us hope that newer and more effective drug therapies are right around the corner to treat PBA.
How about you? Have you experienced any of these symptoms of uncontrolled laughing or crying? If so, what have you taken to try to treat your condition? Please do share your stories and experiences. We all help each other through on-going participation in our discussions.
"Multiple Sclerosis: The Questions You Have The Answers You Need" by Rosalind C. Kalb, PhD
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