Pseudobulbar Affect and Multiple Sclerosis

Pseudobulbar affect is known to occur secondary to neurological conditions, such as multiple sclerosis. There is a close association between multiple sclerosis and Pseudobulbar Affect; however, exactly what this connection is, has scientists and medical experts confused till date. Let us try to understand what we know about the relationship between multiple sclerosis and pseudobulbar affect.

Multiple sclerosis (MS) is a chronic and disabling autoimmune disease that affects the brain, the spinal cord, and the entire nervous system.⁽³⁾ Being an autoimmune disease, in people who suffer from multiple sclerosis, the immune system begins to attack the protective lining or sheath (known as myelin) that covers the nerve fibers in the body.⁽³⁾ This loss of protective sheath of the nerves causes communication problems to develop between the brain and the other parts of the body. Multiple sclerosis can eventually lead to the nerves becoming deteriorated or permanently damaging the nerves.

Multiple sclerosis is known to damage the nervous system, which is primarily responsible for sending signals between the brain and the rest of the body, thus controlling various bodily functions. Damage to the nervous system causes these signaling to fail. Multiple sclerosis can affect feeling, vision, movement and even emotions.

In certain cases, multiple sclerosis causes a disruption in the manner in which you feel various emotions, leading to a condition known as pseudobulbar affect (PBA).

Pseudobulbar affect is a neurological condition which causes you to suddenly start laughing or crying or experiencing other emotional outbursts.⁽⁴⁾ There is usually no specific trigger for the outburst in pseudobulbar affect. Pseudobulbar affect is actually a result of multiple sclerosis.

In normal circumstances, the cerebral cortex, or the front part of the brain, communicate with the back part of the brain or the cerebellum in order to have a control on your emotional response to any particular situation. However, due to multiple sclerosis or any other condition of the nervous system, the cerebellum becomes damaged. Lesions can also cause the cerebellum to become damaged. This damage causes a disruption in the communication between the two parts of the brain and pseudobulbar affect (PBA) is believed to be the result of this miscommunication. Basically, you can say that the brain ‘short circuits’ and you no longer have any control over your emotional responses. This condition is also known as disinhibition.

Pseudobulbar Affect can affect people not just with multiple sclerosis, but also people who are suffering from similar conditions. It is believed that more than half of all the people who suffer a stroke may experience pseudobulbar affect (PBA) at some point or another. Pseudobulbar Affect can also result from or can be seen with medical conditions, such as⁽¹⁾

• Attention Deficit Hyperactivity Disorder (ADHD)
• Parkinson’s disease.
• Alzheimer’s disease.
• Brain tumors.
• Traumatic brain injuries.
• Grave’s disease.

One of the most recognizable symptoms of pseudobulbar affect is an inappropriate emotional reaction.⁽⁴⁾ Pseudobulbar affect is also sometimes referred to as emotional incontinence. This condition may cause you to burst out laughing at a sad situation, such as a funeral or you can start crying during a happy situation, such as an award ceremony. Whatever be the case, you are likely to feel emotions that are totally unrelated to your mood when suffering from pseudobulbar affect.

For people having multiple sclerosis, pseudobulbar affect generally occurs alongside the symptoms of depression. However, there is no similarity between depression and pseudobulbar affect. For example, unlike how depression builds up to the final condition, pseudobulbar affect occurs suddenly and is not connected to your present emotional state or mood. When pseudobulbar affect begins, it often is difficult to tell apart the symptoms of pseudobulbar affect from those of depression. However, if you pay close attention to the suddenness of your emotional outbursts, you will be able to determine if your condition warrants a visit to the doctor.

The majority of people suffering from pseudobulbar affect actually never end up getting diagnosed. This is because people with pseudobulbar affect are usually already suffering from some of the form of neurological disorder, such as multiple sclerosis, and therefore are likely to be battling through emotional issues already. However, this is not to say that pseudobulbar affect cannot be recognized. There are certain recognizable behaviors specific to pseudobulbar affect, the most typical one being a sudden emotional reaction that is totally unrelated to your present situation.

If you doubt that you are suffering from pseudobulbar affect, then you need to let your doctor know. In order to diagnose pseudobulbar affect, your doctor will first find out about your symptoms. Then, they will ask you several questions; and based on your answers, you will be assigned a score to determine whether you suffer from pseudobulbar affect or not. If you do have pseudobulbar affect, then your doctor will discuss your treatment options with you, keeping in mind your treatment plan for multiple sclerosis that is going already.

Yes, pseudobulbar affect is a treatable condition and it is treated with some of the same medications that treat depression and other similar mental health-related conditions. Medications for treating pseudobulbar affect may include: Luvox (fluvoxamine), Prozac (fluoxetine), Elavil (amitriptyline) and Celexa (citalopram). Research has shown that both SSRIs (selective serotonin reuptake inhibitors) and TCAs (tricyclic antidepressants) can prove to be effective treatments for pseudobulbar affect.^(1,4)

The US Food and Drug Administration (FDA) in 2010 approved a new medication known as Nuedexta for the treatment of pseudobulbar affect in people suffering from multiple sclerosis and other disorders of the nervous system.⁽²⁾

However, SSRIs, TCAs, antidepressants and even the new medication Nuedexta, all have several side effects and they can also interact with the other medications you are taking for multiple sclerosis. This is why you must inform your doctor about all the medications you are taking before he/she decides on your treatment for pseudobulbar affect. Otherwise, you may start experiencing some rather uncomfortable and even serious side effects.

Certain lifestyle changes and adopting healthy habits can help you manage the effects of pseudobulbar affect, even though the condition is caused by a dysfunction inside the brain. For example, try using certain relaxation techniques whenever you feel your emotions going out of control. Relaxing will help you either reduce the intensity and time period of the episode or may even help you avoid the episode of pseudobulbar affect altogether. Deep breathing, yoga, meditation, art, and music therapy, reading a book, etc., are all common relaxation techniques that you may consider for managing the symptoms of pseudobulbar affect.

It is necessary to educate yourself about the differences between depression and pseudobulbar affect. Both of these conditions are typically associated with multiple sclerosis and both are also treated with the same treatment at times. However, there is a key difference in pseudobulbar affect from depression, in that pseudobulbar affect reactions are usually abrupt and sudden in their onset. It is very much possible for you to have pseudobulbar affect without having depression and vice versa. Understanding the difference will help you manage your pseudobulbar affect better.

Studies have observed that changing your posture when you feel an episode of pseudobulbar affect coming on can help put a stop to an unwanted pseudobulbar affect reaction. You should also focus on relaxing the muscles that feel tense just before a pseudobulbar affect episode begins. Over a period of time you will be better able to identify which muscles get affected. Relaxing these muscles can also help you stop a pseudobulbar affect reaction before it happens.

Letting your friends, family, and colleagues know about your condition will help you cope with your condition in an easier manner. This is especially so because pseudobulbar affect has a profound impact on your social life. If people around you are able to recognize the symptoms of pseudobulbar affect, they will be prepared to help ease the anxiety of the situation and may even help prevent an episode of pseudobulbar affect.

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