Pseudobulbar Affect (PBA)
Recognizing the Symptoms of PBA
Pseudobulbar affect (PBA) is a neurologic effect that occurs in 10 percent of people with MS, although some research suggests a much larger percentage. It is characterized by sudden, uncontrollable expressions of laughter or crying without an apparent trigger.
PBA is equally common among men and women and occurs in other chronic, neurological conditions such as Parkinson’s disease and amyotrophic lateral sclerosis (ALS). Once it starts, it cannot be controlled voluntarily. This behavior is extremely distressing as well as embarrassing to those who experience it. PBA is not yet well recognized or understood. With more education, people with MS will know to consult their MS neurologist if they experience any of its symptoms.
PBA is distinguished from depression by its sudden emotional reactivity. Though depression and PBA both appear to result from the disease process of MS itself, PBA is specifically related to a certain set of behaviors, such as sudden laughing or crying. You could have MS and depression and not experience PBA, or you could have PBA but not have depression. Or you could experience both. The etiology of PBA is unclear and it is believed to be a disorder of mood related to the disruption of nerve impulses in the central nervous system.
To learn more, watch MSAA’s educational video on PBA, “Why Do I Cry or Laugh Inappropriately?”
In 2010, Nuedexta® (dextromethorphan hydrobromide and quinidine sulfate) was approved by the Food and Drug Administration (FDA) to treat PBA episodes in MS. Nuedexta is the first and only approved treatment for PBA at this time.
Some doctors advocate using certain antidepressant medications, including the SSRIs (selective serotonin reuptake inhibitors), such as Celexa® (citalopram) and Zoloft® (sertraline). Although their exact course of action is not clear, they appear to be effective for many. These antidepressants are typically administered at a lower dose than for depression. While these medications may well help to manage the symptoms of PBA, they do not cure its underlying cause.
If you experience PBA, hope is in sight, as doctors and researchers are learning more about this symptom. The Center for Neurologic Study Emotional Lability Scale is a good screening tool available for PBA. You can complete it at your MS neurologist’s office. If you have PBA, your MS neurologist will to determine which medication is best for you.
By Dr. Miriam Franco MSW, PsyD, MSCS
Professor, Sociology Department
Member, MSAA Healthcare Advisory Council