Pseudobulbar Affect

1. Ade Wijaya, MD
October 2017

2. Outline:
 Introduction
 Epidemiology
 Pathophysiology
 Diagnosis
 Differential diagnosis
 Treatment
 Summary

3. Introduction
 Uncontrolled laughing and crying disproportionate to social context
 Emotional affect disinhibition
 Have been noted since at least the late 19th century
 Often underdiagnosed and undertreated
 Quality of Life ?
Ahmed, A., & Simmons, Z. (2013). Pseudobulbar affect: prevalence and management. Therapeutics and clinical risk management, 9, 483.
Miller, A., Pratt, H., & Schiffer, R. B. (2011). Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments.Expert Review of Neurotherapeutics, 11(7), 1077-1088.
Work, S. S., Colamonico, J. A., Bradley, W. G., & Kaye, R. E. (2011). Pseudobulbar affect: an under-recognized and under-treated neurological disorder. Advances in therapy, 28(7), 586-601.

4. Epidemiology
 Higher prevalence of anxiety symptoms and poorer social functioning
 Higher prevalence of diagnosable psychiatric disorders
 30%–35% of patients with PBA are depressed
 Prevalence: 5-50 %
 Crying > laughter >> anger
Ahmed, A., & Simmons, Z. (2013). Pseudobulbar affect: prevalence and management. Therapeutics and clinical risk management, 9, 483.

5. Etiology
Pathological Laughing and Crying Scale (PLACS)
Center for Neurologic Study-Lability Scale (CNS-LS)
Work, S. S., Colamonico, J. A., Bradley, W. G., & Kaye, R. E. (2011). Pseudobulbar affect: an under-recognized and under-treated neurological disorder. Advances in therapy, 28(7), 586-601.

6. Pathophysiology
 Disinhibition
 Complex pathways
 Corticopontine-cerebellar circuit
 Cerebellum as “gate-control” of emotions ; modulation
 Serotonin and glutamate
Miller, A., Pratt, H., & Schiffer, R. B. (2011). Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments.Expert Review of Neurotherapeutics, 11(7), 1077-1088.
Ahmed, A., & Simmons, Z. (2013). Pseudobulbar affect: prevalence and management. Therapeutics and clinical risk management, 9, 483.

8. Diagnosis

9. Diagnosis
Lapchak, P. A. (2015). Neuronal Dysregulation in Stroke-Associated Pseudobulbar Affect (PBA): Diagnostic Scales and Current Treatment Options. Journal of neurology & neurophysiology, 6(5).

10. Diagnosis

11. Diagnosis

12. Treatment
 The goal of treatment of PBA is to diminish the severity and frequency of episodes
 primarily involved use of medications that modulate serotonergic or glutamatergic
neurotransmission
 Serotonergic and antiglutamanergic
Miller, A., Pratt, H., & Schiffer, R. B. (2011). Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments.Expert Review of Neurotherapeutics, 11(7), 1077-1088.
Ahmed, A., & Simmons, Z. (2013). Pseudobulbar affect: prevalence and management. Therapeutics and clinical risk management, 9, 483.

13. Treatment
Miller, A., Pratt, H., & Schiffer, R. B. (2011). Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments.Expert Review of Neurotherapeutics, 11(7), 1077-1088.

14. Summary
 Pseudobulbar affect (PBA) is a common comorbidity and source of psychosocial
disability in patients with neurologic insult.
 Underdiagnosed and undertreated
 Corticopontine-cerebellar circuit
 Treatment: antiglutamanergic and serotonergic