Multiple Sclerosis is a disease which can impact one's mood. Depression and even euphoria can be part 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 outward 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, 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 (ALS), 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 NeurologicStudy-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, an area associated 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?
Counseling and talk therapy have not been shown to be effective treatments for PBA. Treatments that have been used to control PBA include amitriptyline, levodopa, despiramine, fluoxetine, and fluvoxamine. In 2010, Nuedexta™ was approved by the US Food and Drug Administration (FDA) to treat pseudobulbar affect in MS and other neurologic disorders. This oral medication which is taken twice daily after a weeklong titration period combines dextromethorphan hydrobromide and quinidine sulfate (20mg/10mg). Some of the most common side-effects of Nuedexta™ in clinical trials were diarrhea, dizziness, cough, vomiting, weakness, peripheral edema, urinary tract infection, influenza, and flatulence.
If you suspect that you or a loved one has pseudobulbar affect (PBA), 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. Remember that PBA is not the same as depression. PBA is uncontrollable and outbursts, which may be brief lasting only seconds to minutes, have no specific connection to underlying thoughts. PBA is a neurologic disease, not a mental health disorder.
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
National MS Society