Some people who suffer from neurologic conditions, such as stroke, dementia and amyotrophic lateral sclerosis, or ALS, as well as those who’ve sustained brain injuries, face an added indignity: uncontrollable outbursts of laughing or crying.
Called pseudobulbar affect, clinicians say PBA is vexing for many who suffer from it; frequently, a person isn’t quite sure what’s going on and may not bring it up with his or her doctor. “Often times we don’t ask or patients are embarrassed to talk about it,” says Dr. Lynn Vidakovic, an attending physician in rehabilitation at the Rehabilitation Institute of Chicago, which specializes in rehab for areas ranging from stroke to brain injuries.
But research finds 28 to 52 percent of stroke survivors suffer from the condition, according to the American Stroke Association. “It can be extremely debilitating and affect [people’s] relationships professionally, personally, socially,” Vidakovic says. With PBA, damage to the brain caused by a tumor, traumatic injury or neurologic condition can affect a person’s ability to regulate his or her emotions. “The emotional outplay, whether it be laughing or crying, can either be disproportionate or it can be completely inappropriate. Obviously that can be very distressing,” Vidakovic says, adding it can cause a person to withdraw. “It can be socially isolating.”
[Stroke: 10 Ways to Lower Your Risk of Stroke.]
Because many who experience the emotional misfires often don’t know what’s causing them, it’s underreported, says Dr. Felipe De Los Rios, stroke director for the Baptist Health Neuroscience Center, part of Baptist Health South Florida, in Miami. So people don’t know what to do when outbursts occur.
There’s no cure for PBA. But in cases where the underlying problem is addressed or improves — such as where a person gets noticeably better following a stroke or a brain injury — the awkward outbursts may cease to be as pronounced or occur less often, and medication may also help a person regain control of his or her emotions. “In those kind of cases, you’re not going to have progression of symptoms, [and] people can expect to have more emotional control,” says Dr. Osman Mir, an assistant professor of neurology at Texas A&M University in College Station and director of the Baylor Health Care System Telestroke Program in Dallas. For people with progressive diseases like ALS, PBA may worsen. But even in such cases, medication can reduce the number and severity of the emotional outburst episodes, Mir says.
Experts say those with a neurologic condition or who have sustained brain damage who suspect an issue with emotional control should speak with their doctor and undergo an evaluation to ensure a proper diagnosis. And family members advocating for loved ones with neurologic disorders, like Alzheimer’s disease, are also encouraged to speak up about concerns. A comprehensive evaluation should include screening for any underlying mental health or psychiatric cause, Vidakovic says. If the issue is determined to be PBA and symptoms are mild, experts say, simply knowing that’s the source of the problem may be enough to cope — and explain to family and friends the cause for emotional outbursts. “Not everyone needs treatment,” De Los Rios says. “Many times just actually being aware that this is a manifestation of a neurologic disorder — it’s enough.”
[See: 5 Ways to Cope With Mild Cognitive Impairment.]
However, where symptoms are more disruptive and affect function, clinicians say certain medications may help. The drug Nuedexta is the only treatment approved by the Food and Drug Administration specifically for PBA. Research supporting its effectiveness was done on patients with ALS, which is also known as Lou Gehrig’s disease, and multiple sclerosis. But doctors sometimes prescribe it for post-stroke patients and others with PBA as well. The FDA notes, however, that the medication wasn’t shown to be safe and effective for treating other types of emotional lability that frequently occur with Alzheimer’s disease and other types of dementia.
Patients prescribed Nuedexta typically take the drug once daily the first week and then increase the dose to take it twice daily after that. “There can be side effects with it. You can get nauseous, you can get dizzy,” De Los Rios says. Other common side effects include cough, vomiting and swelling of the feet and ankles. Less commonly, it can affect a patient’s heart rate or rhythm; so your physician may need to do an electrocardiogram, or EKG, to check your heart function.
Clinicians add that the drug’s expense deters some patients. Nuedexta costs, on average, more than $700 for 60 capsules (a 30-day supply), according to GoodRx.com, which provides prescription pricing information. So check insurance coverage and what your out-of-pocket costs would be in advance.
Alternatively, experts say certain antidepressants may be an option to treat PBA as well. Those include tricyclic antidepressants, such as amitriptyline or nortriptyline, and selective serotonin reuptake inhibitors, or SSRIs like Prozac (also called fluoxetine). “We think that those can help, too,” De Los Rios says.
[See: Emerging Treatments for Alzheimer’s Disease.]
Talk with your doctor about all options and the potential benefits and harms of each medication. “We typically try different things,” De Los Rios says. “But it [comes] down to really how severely affected the person is by this, and if they want to take something to manage it.”
More from U.S. News
Easy Ways to Protect Your Aging Brain
What Only Your Partner Knows About Your Health
Addressing Pseudobulbar Affect: How to Regain Emotional Control originally appeared on usnews.com
