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Pseudobulbar Affect Q&A

Dr. Randall Kaye, Senior Vice President of Medical Affairs & Chief Medical Officer at Avanir Pharmaceuticals took some time out of his busy day to help explain the basics about Pseudobulbar affect (PBA).

Q: What is PBA?
A: Pseudobulbar affect (PBA) is a neurologic disorder characterized by episodes of unpredictable crying or laughing that can be frequent, severe and disruptive to everyday life. These outbursts are often incongruent with the patient’s current emotional state, leaving them to laugh or cry when they don’t find things funny or sad. Episodes are often so disruptive they can interfere with routine activities or cause patients to avoid social situations altogether.

Q: Who gets PBA?
A: Patients with neurologic conditions, including stroke, traumatic brain injury, Multiple Sclerosis, Alzheimer’s disease and other dementias, Parkinson’s disease or Lou Gehrig’s disease (ALS).Q: Who gets PBA?

Q: What causes PBA?
A: PBA occurs when the primary neurological condition damages the areas of the brain controlling normal emotional expression, causing a “short circuit” and triggering the episodes of unpredictable crying or laughing.

Q: How is PBA diagnosed?
A: PBA is often goes undiagnosed or misdiagnosed as depression or part of the primary neurologic disease.  In fact, it’s a separate, treatable neurologic condition. PBA is may be diagnosed using the CNS-LS scale, a short questionnaire patients complete to provide a quantitative measure of perceived frequency of PBA episodes for physicians to more accurately diagnose it. A CNS-LS score of 13 or higher may suggest PBA symptoms.

The following are tell-tale signs a patient may have PBA, and they should talk to their doctor:

  • The patient bursts out crying or laughing for no apparent reason.
  • The patient cries or laughs at inappropriate times.
  • The patient experiences outbursts of emotion that are exaggerated or inappropriate for the situation.
  • Patients can’t control their tears or laughter, even when they try to.
  • Patients socially isolate themselves out of fear of having an episode in public.

Q: How is it treated?
A: There is an FDA-approved treatment for PBA to help diminish the frequency of episodes. Patients should talk to their doctor if they think they have PBA.

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