You are here:

Inappropriate laughing or crying: how common is the pseudobulbar affect?

Published on

Summary

Some people with MS find that they laugh or cry for little reason or at inappropriate times. This is called pseudobulbar affect. This study aimed to establish how common it is by establishing a registry where health professionals in the USA could report cases of pseudobulbar affect.

Nearly half (46%) of people with MS had scores on their questionnaire which suggested that they might have pseudobulbar affect and women were more likely to be in this group than men. Of these, about a quarter (12% of the total) scored highly suggesting a stronger likelihood of pseudobulbar affect. Those with pseudobulbar effect had a significantly reduced quality of life.

The researchers stress the importance of health professionals recognising pseudobulbar affect so that appropriate support can be offered.

Background

Some people with MS find that they laugh or cry for little reason or at inappropriate times. This is called pseudobulbar affect. It happens because the MS lesions have occurred in areas of the brain that regulate the emotions so someone might laugh or cry uncontrollably but this does not mean that they are very happy or very sad.

Pseudobulbar affect can be very embarrassing and disabling in social situations so people may avoid getting into circumstances where this could happen. This can contribute to being isolated from others.

You can watch a five minute video explaining pseudobulbar affect (PBA). Although the video is about PBA after having a stroke, the explanation applies to MS equally well.

How this study was carried out

Pseudobulbar affect occurs in a wide range of neurological conditions and is thought to be under reported. This study aimed to establish how common it is, and whether it corresponds to any particular clinical features, by establishing a registry where health professionals in the USA could report cases of pseudobulbar affect. People with stroke, amyotrophic lateral sclerosis (ALS) – which is the most common form of motor neurone disease, multiple sclerosis, traumatic brain injury, Alzheimer's disease, and Parkinson's disease were eligible to be included in the registry. Only the information about people with MS will be summarised here.

All participants were over 18 years old. Information was collected about age, gender, date of diagnosis and the use of any antidepressant or antipsychotic medication. Participants completed a questionnaire about their quality of life and another questionnaire to measure their emotional lability (whether their emotional reactions were out of proportion to what was happening).

What was found

A total of 5,290 people were enrolled at 173 sites in the USA of which almost a quarter (1,215) had MS. People with MS had an average age of 49 and just over three quarters (80%) were women. The average time since diagnosis was ten years. Over a third (38%) were on antidepressant or antipsychotic medication.

Nearly half (46%) of people with MS had scores on their questionnaire which suggested that they might have pseudobulbar affect and women were more likely to be in this group than men. Of these, about a quarter (12% of the total) scored highly suggesting a stronger likelihood of pseudobulbar affect. Those with pseudobulbar affect had a significantly reduced quality of life.

What does it mean?

The research found that pseudobulbar affect was common in the six neurological conditions that were studied although the proportion of people experiencing it varied from one condition to another. The episodes of inappropriate laughing or crying appeared very similar in all the conditions which suggests that the symptoms are caused by the location of the lesions in the brain, rather than something specific to each neurological condition. The researchers suggest that disruption of nerve networks involved in regulating the expression of emotions are affected.

The finding that pseudobulbar affect corresponded to a lower overall quality of life was in agreement with previous studies which had also found that it could have an impact on relationships and could contribute significantly to someone becoming housebound.

The authors acknowledged some limitations in their study including the fact that they did not assess people for other conditions, such as depression, which might explain excessive crying or laughing. Depression is common in MS so this may be an important point to note although depression is not clearly associated with increased crying but with depressed mood.

The researchers stress the importance of health professionals recognising pseudobulbar affect so that appropriate support can be offered.

Brooks BR, Crumpacker D, Fellus J, et al.
PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions. .
PLoS One. 2013 Aug 21;8(8):e72232.
abstract
Read the full text of this paper

More about pseudobulbar affect

People with MS may experience a wide range of changes in their emotional state. Some of these will be due to the consequences of living with a long term condition which can be unpredictable. Some of them will be a direct result of the MS lesions affecting areas of the brain involved in mood or the control of emotions.

Mood changes include depression, emotional lability, mood swings and pseudobulbar affect. You can watch a five minute video explaining pseudobulbar affect (PBA). Although the video is about PBA after having a stroke, the explanation applies to MS equally well.

The NICE guidelines for the management of multiple sclerosis in primary and secondary care state that people with MS should be offered full assessment of their emotional state by someone with suitable expertise. If the emotionalism is enough to cause concern or distress, people should be offered treatment with antidepressant therapy or behavioural management strategies.

In 2010 Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) was licensed in the USA as a treatment for uncontrolled laughing or crying. In July 2013, it was approved for use in Europe.

Research by topic areas...

Diagnosis

Marcus JF, Waubant EL.
Updates on clinically isolated syndrome and diagnostic criteria for multiple sclerosis.
Neurohospitalist. 2013 Apr;3(2):65-80.
abstract
Read the full text of this paper

Symptoms and symptom management

Sand PK, Sand RI.
The diagnosis and management of lower urinary tract symptoms in multiple sclerosis patients.
Dis Mon. 2013 Jul;59(7):261-8.
abstract

Disease modifying treatments

Freedman MS.
Teriflunomide in relapsing multiple sclerosis: therapeutic utility.
Ther Adv Chronic Dis. 2013 Sep;4(5):192-205.
abstract

Olival GS, Cavenaghi VB, Serafim V, et al.
Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis.
Arq Neuropsiquiatr. 2013 Aug;71(8):516-20.
abstract
Read the full text of this paper

Other treatments

Mostert J, Heersema T, Mahajan M, et al.
The effect of fluoxetine on progression in progressive multiple sclerosis: a double-blind, randomized, placebo-controlled trial.
ISRN Neurol. 2013 Jul 29;2013:370943.
abstract
Read the full text of this paper

Epidemiology

Ojeda E, Díaz-Cortes D, Rosales D, et al.
Prevalence and clinical features of multiple sclerosis in Latin America.
aga A. Prevalence and clinical features of multiple sclerosis in Latin America. Clin Neurol Neurosurg. 2013 Apr;115(4):381-7.
abstract

Causes of MS

Hon GM, Erasmus RT, Matsha T.
Multiple sclerosis-associated retrovirus and related human endogenous retrovirus-W in patients with multiple sclerosis: A literature review.
J Neuroimmunol. 2013 Aug 15. [Epub ahead of print]
abstract

Paediatric MS

Peche SS, Alshekhlee A, Kelly J, et al.
A Long-Term Follow-Up Study Using IPMSSG Criteria in Children With CNS Demyelination.
Pediatr Neurol. 2013 Aug 27. [Epub ahead of print]
abstract

Physical activity

Sosnoff JJ, Finlayson M, McAuley E, et al.
Home-based exercise program and fall-risk reduction in older adults with multiple sclerosis: phase 1 randomized controlled trial.
Clin Rehabil. 2013 Aug 27. [Epub ahead of print]
abstract

Nogueira LA, Santos LT, Sabino PG, et al.
Walking execution is not affected by divided attention in patients with multiple sclerosis with no disability, but there is a motor planning impairment.
Arq Neuropsiquiatr. 2013 Aug;71(8):521-6.
abstract
Read the full text of this paper

Pathophysiology

Dutta R.
Gene expression changes underlying cortical pathology: clues to understanding neurological disability in multiple sclerosis.
Mult Scler. 2013 Sep;19(10):1249-54.
abstract

Prosperini L, Sbardella E, Raz E, et al.
Multiple sclerosis: white and gray matter damage associated with balance deficit detected at static posturography.
Radiology. 2013 Jul;268(1):181-9.
abstract

Print this page