The reported prevalence of PBA in neurological disease varies widely according to the underlying neurological disorder and study methodology. The Prevalence of Pseudobulbar Affect in Neurological Disorders The purpose of this article is to consider the burden of PBA in neurological disease, its pathophysiology, the challenges of recognition, the available methods for detection and approaches to management of the condition. The indicated use is supported by clinical trial evidence and post-marketing experience. 6 More recently, a combination of dextromethorphan hydrobromide and quinidine sulphate (DM/Q) became the first evidence-based medicine approved in the US and the EU for the symptomatic treatment of PBA, irrespective of underlying neurological aetiology. Historically, the most commonly prescribed medicines were antidepressants, which can be effective but clinical trial data supporting such use are limited and none have regulatory approval for this indication. 5 The condition can cause orexacerbate social isolation, limit the patient’s ability to work and has a detrimental effect on quality of life (QoL).įor many years, most cases of PBA were treated with medications lacking substantive or conclusive clinical evidence of efficacy and safety for this condition. There have been inconsistent nomenclature to describe PBA, particularly in the EU where it has been called ‘emotionalism’, ‘emotional lability’ and ‘emotional incontinence’ among other terms and these have contributed to difficulties in recognition and diagnosis. The independence of PBA from mood, disproportion to inciting stimulus, uncontrollable nature, episodic nature and often stereotypical pattern, help differentiate it from depression and other conditions. The term PBA is perhaps misleading because the problem is not so much of affect but of disconnection between affect and emotional expression: to describe it as ‘disorders of voluntary emotional expression’ may be more accurate. Furthermore, even when PBA manifestations are recognised, they are sometimes mistaken for a sign of depression or simply a general reaction to the burden of the neurological disease. In addition, there is a general lack of awareness of PBA among the healthcare and lay communities: many healthcare workers and patients do not recognise it as a distinct disease manifestation that can be treated. 1–5 PBA is prevalent but under-reported because patients tend not to report their symptoms, and doctors frequently fail to ask about them. PBA was first described by Lépine in the late-nineteenth century as lower cranial nerve palsy, but was later recognised as a frequent manifestation of acquired brain damage with upper motor neuron dysfunction, especially stroke. Pseudobulbar affect (PBA), appearing as abrupt episodes of uncontrollable laughter or crying that are incongruent or independent of mood, occurs in many neurological brain diseases or following brain injury. Pseudobulbar affect, prevalence, pathophysiology, detection, diagnosis, quality of life, clinical management Article: With the availability of an effective treatment for PBA symptoms, it becomes even more pressing to detect the condition so that patients can receive appropriate treatment. A combination of dextromethorphan hydrobromide and quinidine sulphate (DM/Q) has demonstrated significant efficacy in reducing PBA symptoms and a favourable safety profile in a series of clinical trials and in regular clinical use. PBA has been successfully treated with psychoactive drugs, including antidepressants, but these do not have regulatory approval for use in this indication. Data suggest that PBA is underrecognised by neurologists and psychiatrists and many cases go unrecognised or misdiagnosed. The pathophysiology of PBA is incompletely understood, but symptoms are thought to result from damage to neural pathways associated with motor functioning and emotional processing. PBA exacts a severe burden on the patient and care-givers in terms of reduced social functioning and often results in the patient’s isolation. Pseudobulbar affect (PBA) is a condition associated with common neurological diseases or brain injury that manifests as uncontrollable and inappropriate outbursts of laughter or crying.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |