What is the Pseudobulbar Affect (PBA) & How is it Treated?|Connection Between Pseudobulbar Affect (PBA) and MS
Multiple sclerosis (MS) is an autoimmune condition that damages the protective covering of the nerves. The damage caused to the nerves causes disruption in the communication between the brain and body. Multiple sclerosis can also cause damage to the brain and the spinal cord. When MS causes damage to the nerves, it damages the body's central nervous system, affecting the body's movement, vision, feeling, and sometimes even emotions.
Pseudobulbar affect (PBA) is a condition in which a person can suddenly start to laugh or cry or experience any other emotional outburst without it being actually triggered by anything. This is known as a neurological effect and is known to affect nearly 10 percent of patients who have Multiple sclerosis. For years now there is a debate raging about whether or not there is any connection between Pseudobulbar affect and Multiple sclerosis. Today we take a look at what is the connection between MS and the pseudobulbar affect.
What is the Pseudobulbar Affect (PBA)?
Pseudobulbar affect (PBA) is a neurological condition that occurs in nearly 10 percent of patients who have multiple sclerosis (MS). It is a condition in which you can suddenly start to laugh, cry, or experience any other emotional outburst without actually having any trigger.
Pseudobulbar affect (PBA) is common equally between men and women and can also occur in cases where you are suffering from other chronic, neurological conditions apart from MS. These may include:
- Parkinson's disease
- Amyotrophic lateral sclerosis (ALS)
- Traumatic brain injuries
- Attention Deficit Hyperactivity Disorder
- Grave's disease
- Alzheimer's disease
In normal conditions, your cerebral cortex, or the front part of the brain, communicate with the back of the brain, known as the cerebellum for controlling your emotional responses to certain situations. However, when the back part of the brain becomes damaged due to nerve problems. This inhibits proper communication between the front of the brain and the back part of the brain. Pseudobulbar affect (PBA) is thought to be a result of this disruption in communication. It can be said that the brain undergoes a 'short circuit', and you are suddenly left with no control over your emotional response. This is known as disinhibition.
Once the condition begins, it becomes difficult to control your emotions voluntarily. Not only can the resulting behavior from Pseudobulbar affect (PBA) cause distress, but it can often be very embarrassing for the ones who experience it.
The condition of Pseudobulbar affect (PBA) is not yet fully understood and as more research is done on the condition, experts come to know about it and people having MS can also learn more about its symptoms.
According to data from the National Stroke Association, there are over 1 million people in the world who have PBA. Pseudobulbar affect (PBA) is known to affect people who have a nervous system disorder such as MS.
What are the Symptoms of Pseudobulbar Affect (PBA)??
One of the most commonly recognized symptoms of Pseudobulbar affect (PBA) is the lack of appropriate emotional response. Also known as emotional incontinence, Pseudobulbar affect (PBA) may cause a person to suddenly burst out laughing at a sad situation or suddenly start crying when someone is telling a joke. PBA makes a person feel emotions that are not related to your present mood or you may feel the opposite emotions to what you should be experiencing at that particular time.
In people who have MS, Pseudobulbar affect (PBA) is a condition that may very well occur as symptoms of depression. However, PBA differs from depression in that it is a sudden occurrence and it is not connected to your emotional state or mood. In the beginning, it is difficult to disassociate the symptoms of depression from those of Pseudobulbar affect (PBA). However, when you pay close attention to your sudden emotional outbursts or the changes in your normal emotional responses, you will be able to tell your symptoms apart from depression.
How is Pseudobulbar Affect (PBA) Diagnosed?
Many people who have MS and are also suffering from Pseudobulbar affect (PBA), go through their lives without getting diagnosed with PBA as it is very difficult to distinguish Pseudobulbar affect (PBA) from the numerous emotional issues that a person experiences when having MS. However, Pseudobulbar affect does have some recognizable symptoms in terms of your behavior. The most common symptom of Pseudobulbar affect that helps it get diagnosed is your sudden emotional responses that are unrelated to the situation you are in.
In order to diagnose PBA, your doctor will take a full history of your symptoms from you and your family members or loved ones. They will ask you several questions before determining if you have Pseudobulbar affect or not.
Keep in mind that just because you have MS, it does not mean that you will also be having PBA.
Treatment for Pseudobulbar Affect (PBA) and Effect on MS
There are certain medications that can be used for treating Pseudobulbar affect (PBA). These medications are typically used in the treatment of depression and other mental health condition. Some of these drugs include:
- amitriptyline (brand name: Elavil)
- citalopram (brand name: Celexa)
- fluoxetine (brand name: Prozac)
- fluvoxamine (brand name: Luvox)
- Tricyclic antidepressants (TCAs) and SSRIs (selective serotonin reuptake inhibitors) are also considered to be effective in treating Pseudobulbar affect (PBA).
The US Food and Drug Administration (FDA) approved a new drug in 2010 for the treatment of Pseudobulbar affect (PBA). The drug, sold under the brand name of Neudexta, targets a certain chemical in the nervous system and is known to especially help in patients who also have MS or other nervous system disorders.
Like all medications, these medications also have side effects and can also interact with other drugs. This is why you should always be clear with your doctor about what other medications you are taking before you start treatment for PBA.
While there is no cure for MS and Pseudobulbar affect (PBA), with a change in lifestyle and by following healthy habits, you will be able to reduce the impact of Pseudobulbar affect and MS. There are several relaxation techniques that have been found to not only help in Pseudobulbar affect (PBA) but also help you get relief from MS symptoms. These techniques include:
While research has so far shown that there is some connection between Pseudobulbar affect (PBA) and MS, further research is still required to clearly establish what this connection is and why PBA is more commonly seen in people having MS. If you suspect that you may be having Pseudobulbar affect (PBA), then it is important that you discuss with your doctor about the various differences between depression and PBA. Many times, individuals mistake depression to be PBA and vice versa. Depression and PBA are both commonly associated with MS and both can also be managed with similar types of treatments. However, you can also have PBA without having depression and you can be suffering from depression without having PBA. Your doctor will be the correct person to guide you and help you understand the difference between the two so that you can manage your symptoms better.
If you feel like you are about to have an episode of Pseudobulbar affect (PBA), then sometimes simple things as just changing your posture is known to help stop an unwanted PBA episode. Relaxing the muscles that you know become tense just before a PBA reaction, will also help you avoid an episode.
If you are diagnosed with Pseudobulbar affect (PBA), then remember that communication openly and honestly about your condition to your loved ones will help ease the anxiety associated with the symptoms of Pseudobulbar affect (PBA).
- Miller, A., 2006. Pseudobulbar affect in multiple sclerosis: toward the development of innovative therapeutic strategies. Journal of the neurological sciences, 245(1-2), pp.153-159.
- Feinstein, A., 2011. Multiple sclerosis and depression. Multiple Sclerosis Journal, 17(11), pp.1276-1281.
- Feinstein, A., 2004. The neuropsychiatry of multiple sclerosis. The Canadian Journal of Psychiatry, 49(3), pp.157-163.