PBA Could Be A Cause OF MS Emotional Outbursts

Sad Treatment Options

Unexplainable Crying and Laughing Episodes Could Be Caused By PBA if You Have MS

PseudoBulbar Affect, (PBA), is a secondary condition that usually occurs from someone who has had a brain injury, stroke or TIA, Alzheimer’s, dementia, Parkinson’s disease, or neurological conditions such as ALS, Lou Gehrig’s disease, or Multiple Sclerosis.  It is sometimes referred to as emotional lability, pathological crying or laughter, and emotional incontinence.

About 2 million Americans have PBA, and an estimate of 10% of these has MS, but in this 10%, most of it is seen in those with chronic Progressive MS. The cause of PBA is controversial although it is thought to be from bilateral lesions in the descending corticobulbar tract in which failure of controlled emotions leads to the release of laughing and/or crying episodes from the brain stem.  In essence, disruptions of the neural network that controls the generation and regulation of motor output of emotions is the cause. Most people with PBS have experienced significant impact of social dysfunctions causing withdrawing from people due to the embarrassing effects of the inappropriate outbursts. It is important for family and caregivers to understand the symptoms and cause of this disorder in order to help obtain appropriate diagnosis and treatment.  It is also important that if you have PBA that you explain this to others that you are around so when an episode happens that it would be understood. Those with this often cry with happy news and laugh uncontrollable with sad news which often is where “inappropriate” part comes in to play.

Where this differs from clinical depression is many depressed symptoms such as sadness and crying can last for weeks or months but the PBA is last only a few seconds but it can happen several times a day. There are two measurements to able to diagnosis this, PLACS and CNS-LS. Both of these are scales derived from different people in which the scores of these questions deliver the diagnosis.  The PLACS quantifies aspects of laughter and crying such as relationships between the episodes to contributing factors, duration and degree of voluntary control and the inappropriate. 8 items relate of laughing and crying with scores from 0-3 which if al scores added up to 13 the diagnosis of PBA would be made. The CNS-LS, made by the Center for Neurologic Study-Lability Scale, is made up of 7 questions, 4 for laughter and 3 for tearfulness or crying. 1 equals never applies where 5 is most of the time. If the score is 13 or higher here it will provide the diagnosis.

The treatment recommended most by the FDA is an oral medication called Dextromethorphan, Nuedexta.  Other management tips include:

  • Be open to problem so people aren’t surprised or confused when episode takes place
  • Distract yourself by any means such as thinking about something different or concentrating on an unrelated item
  • Take slow deep breaths
  • Relax, or have someone massage your neck and shoulders

Some studies published feel that medications really don’t provide the help that is needed but with combines treatments could help relieve some of the symptoms. To see if you suffer from PBA you can take the 7 question assessment on line by going to PBAfacts.com or you can have information sent to you as the patient or caregiver. Your neurologist can also assist you with directing you to a person who is qualified to help obtaining the diagnosis.

MS Blogger and Multiple Sclerosis Activist shares her journey living with MS, tips for others living MS and her husband, Steve, offers his insight as a caregiver for MS.