What is pseudobulbar affect
Pseudobulbar affect (PBA) is also known as emotional lability, pathological crying and laughing, or emotional incontinence. It is a medical condition that causes sudden moments of uncontrollable episodes of crying or laughing. Most of these emotional outbursts occur at inappropriate times, causing uncomfortable situations for not only the patient but also people around them. PBA can be commonly misdiagnosed as depression. PBA is not depression.
Pseudobulbar affect statistics
What causes pseudobulbar affect
PBA can occur in people with neurologic disorders such as stroke, dementia, multiple sclerosis (MS), Lou Gehrig’s disease, or people with traumatic brain injury.
What are the symptoms of pseudobulbar affect
The Center for Neurologic Study-Lability Scale (CNS-LS) developed simple 7 question scale that can help you determine if you should talk to your doctor about PBA. A score of 13 or higher can be suggestive of PBA. Remember that only doctors can diagnose PBA. If you feel like you may have PBA, consult with your doctor.
Take the test and get your score here.
Experts recommend the following non-drug related approaches for managing PBA:
The most important step in treating PBA is to make sure the correct diagnosis is made. Due to the symptoms which include uncontrollable crying, PBA was often previously misdiagnosed as depression. Therefore, many drugs prescribed for PBA patients in the past included tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI). Nuedexta (previously called Zenvia) is the only drug approved for PBA by the FDA.
Nuedexta (dextromethorphan HBr and quinidine sulfate) capsule was approved by the FDA for PBA (October 29th, 2010).
Dosage forms: capsule containing 20 mg dextromethorphan hydrobromide and 10 mg quinidine sulfate in a brick red gelatin capsule with “DMQ/20-10” printed in white ink on the capsule.
Dosing: One capsule daily by mouth for the initial seven days of therapy and one capsule every 12 hours starting on the eighth day onward.
Common Side effects: diarrhea, dizziness, cough, vomiting, asthenia (lack of energy or abnormal physical weakness), peripheral edema, urinary tract infection, influenza, flatulence
Severe side effects: Thrombocytopenia (lower than normal blood cell fragments called platelets which can lead to bleeding), hepatitis (inflammation of the liver), QT prolongation (causing abnormality in your heart’s electrical system causing abnormal heartbeats), left ventricular hypertrophy or dysfunction
Efficacy: The efficacy of Nuedexta was demonstrated in a 12-week trial. 107 patients were on Nuedexta ( dextromethorphan 20 mg/quinidine 10 mg), 110 patients on Nuedexta (dextromethorphan 30 mg/quinidine 10 mg), and 109 patients on placebo. Participants had an underlying amyotrophic lateral sclerosis (ALS) or multiple sclerosis. There was a statistically significant reduction in laughing and crying episodes with patients on Nuedexta versus placebo.
National Stroke Association: Pseudobulbar Affect
Nuedexta. Avanir Pharmaceuticals, inc.(2013). Prescribing Information
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