The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration
- PMID:30890891
- PMCID: PMC6065587
- DOI: 10.2147/DNND.S34160
The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration
Abstract
Pseudobulbar affect is a disorder resulting from neurologic damage manifesting as sudden, stereotyped affective outbursts that are not reflective of internal emotion. A literature review was completed to examine the current understanding of the epidemiology, characterization, diagnosis, pathophysiology, and treatment of pseudobulbar affect. This review revealed that it is common in neurodegenerative disorders but is poorly recognized, placing significant impacts on patients and their families. The disorder appears to result from a disruption of the cortico-limbic-subcortical-thalamic-pontocerebellar network involved in emotional expression and regulation with resulting disruptions of neurotransmitter systems. Effective treatment is available with agents such as selective serotonin reuptake inhibitors and dextromethorphan combined with quinidine, but further well-designed comparative studies are needed. Advances in technology such as neuroimaging may enhance knowledge about the pathophysiology of this disorder, and help guide future interventions.
Keywords: epidemiology; neurodegenerative disease; pathological laughing and crying; pathophysiology; pseudobulbar affect; treatment.
Conflict of interest statement
Disclosure The authors report no conflicts of interest in this work.
Similar articles
- Dextromethorphan/quinidine for the treatment of pseudobulbar affect.Patatanian E, Casselman J.Patatanian E, et al.Consult Pharm. 2014 Apr;29(4):264-9. doi: 10.4140/TCP.n.2014.264.Consult Pharm. 2014.PMID:24704895Review.
- Dextromethorphan/quinidine sulfate for pseudobulbar affect.Rosen H.Rosen H.Drugs Today (Barc). 2008 Sep;44(9):661-8. doi: 10.1358/dot.2008.44.9.1258664.Drugs Today (Barc). 2008.PMID:19137121Free PMC article.Review.
- Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup.Villeneuve Y, Cruz-Santiago D, Masson H, Clerc D.Villeneuve Y, et al.SAGE Open Med Case Rep. 2020 Jun 3;8:2050313X20921076. doi: 10.1177/2050313X20921076. eCollection 2020.SAGE Open Med Case Rep. 2020.PMID:32547756Free PMC article.
- Crying and suicidal, but not depressed. Pseudobulbar affect in multiple sclerosis successfully treated with valproic acid: Case report and literature review.Johnson B, Nichols S.Johnson B, et al.Palliat Support Care. 2015 Dec;13(6):1797-801. doi: 10.1017/S1478951514000376. Epub 2014 Jun 11.Palliat Support Care. 2015.PMID:24916672Review.
- Treatment of pseudobulbar affect (PBA) in a patient with a history of traumatic brain injury, partial brain resection, and brainstem stroke: a case report.Young FG, Nguyen D.Young FG, et al.J Med Case Rep. 2020 Dec 4;14(1):235. doi: 10.1186/s13256-020-02525-3.J Med Case Rep. 2020.PMID:33272325Free PMC article.
Cited by
- Survivorship Issues in Adult Patients With Histiocytic Neoplasms.O'Brien K, Dave R, Shekhar S, Hannah-Shmouni F, Comis LE, Solomon BI, Chen M, Gahl WA, FitzGibbon E, Gochuico BR, Estrada-Veras JI.O'Brien K, et al.J Natl Compr Canc Netw. 2021 Nov;19(11):1312-1318. doi: 10.6004/jnccn.2021.7096.J Natl Compr Canc Netw. 2021.PMID:34781266Free PMC article.Review.
- Thalamic pathology in frontotemporal dementia: Predilection for specific nuclei, phenotype-specific signatures, clinical correlates, and practical relevance.McKenna MC, Lope J, Bede P, Tan EL.McKenna MC, et al.Brain Behav. 2023 Feb;13(2):e2881. doi: 10.1002/brb3.2881. Epub 2023 Jan 7.Brain Behav. 2023.PMID:36609810Free PMC article.Review.
- Prediction of Cardiovascular Risk to Guide Primary Prevention.Curfman GD.Curfman GD.JAMA Intern Med. 2018 Sep 1;178(9):1240-1241. doi: 10.1001/jamainternmed.2018.3131.JAMA Intern Med. 2018.PMID:30039158Free PMC article.
- A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis.Memon W, Rose EK, Akram A, Simba B.Memon W, et al.Cureus. 2021 Feb 22;13(2):e13494. doi: 10.7759/cureus.13494.Cureus. 2021.PMID:33777579Free PMC article.
- Resting state fMRI analysis of pseudobulbar affect in Amyotrophic Lateral Sclerosis (ALS): motor dysfunction of emotional expression.Trojsi F, Di Nardo F, D'Alvano G, Caiazzo G, Passaniti C, Mangione A, Sharbafshaaer M, Russo A, Silvestro M, Siciliano M, Cirillo M, Tedeschi G, Esposito F.Trojsi F, et al.Brain Imaging Behav. 2023 Feb;17(1):77-89. doi: 10.1007/s11682-022-00744-4. Epub 2022 Nov 12.Brain Imaging Behav. 2023.PMID:36370302Free PMC article.
References
- Cummings JL. Involuntary emotional expression disorder: definition, diagnosis, and measurement scales. CNS Spectr. 2007;12(4 Suppl 5):11–16. - PubMed
- Duda JE. History and prevalence of involuntary emotional expression disorder. CNS Spectr. 2007;12(4 Suppl 5):6–10. - PubMed
- Gondim FA, Thomas FP, Oliveira GR, Cruz-Flores S. Fou rire prodromique and history of pathological laughter in the XIXth and XXth centuries. Rev Neurol (Paris) 2004;160(3):277–283. - PubMed
- Martin CM. It’s nothing to laugh about: understanding disorders of emotional expression. Consult Pharm. 2007;22(9):732–742. - PubMed
- Miller A, Pratt H, Schiffer RB. Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments. Expert Rev Neurother. 2011;11(7):1077–1088. - PubMed
Publication types
Related information
LinkOut - more resources
Full Text Sources
Other Literature Sources