A good cry can do wonders for the body and mind. Same with a good laugh. But what if you had no control over whether you laughed or cried? That’s what it’s like for people with PseudoBulbar Affect (or PBA), a condition that causes uncontrollable crying and/or laughing. It affects some two million Americans and potentially another seven million Americans who have PBA-like symptoms, according to PBAinfo.org.
PBA is a pattern of behavior where your emotions “swing wildly and randomly,” explains Kevin Gaffney, MD, neurologist at Mischer Neuroscience Associates and Stroke Medical Director at Memorial Hermann The Woodlands Hospital. To an observer, it might look like someone sitting quietly who suddenly starts laughing or crying hysterically for either no good reason or for what seems to be the opposite of a good reason (laughing at a sad commercial on TV—watch a video of PBA to see this dynamic in action). People who have PBA may not even realize they’re laughing or crying, or if they do, they may not understand why, says Fiona Gupta, MD, a neurologist at Hackensack University Medical Center who works with many people suffering from PBA. Pseudobulbar Affect causes distress for both the person suffering from it and for those observing it while it happens, which can be frequently, continuously, and/or in clusters, Dr. Gupta says.
Observers tend to be caregivers, Dr. Gupta notes, because those who suffer from PBA are almost always suffering from an underlying brain condition. There are a large number of diseases that can lead to PBA, says Dr. Gaffney, including stroke, multiple sclerosis, and ALS, all of which tend to be more common in the elderly population, which means that PBA is most often seen in the elderly. Nevertheless, PBA can also be the result of a traumatic brain injury or a brain tumor, either of which can strike at any age. Generally, what’s happening is that the illness or condition affects the frontal lobe of the brain and impairs the ability to suppress emotions or to express emotions in appropriate ways at appropriate times.
PBA can be very debilitating, particularly before it’s diagnosed, Dr. Gupta says. Those suffering from it may be thought to be depressed or manic, and before a diagnosis is made, there is a “constellation of puzzle pieces” that a neurologist must put together, including the patient’s primary condition and their previous medical history.
Pseudobulbar Affect treatment is precisely that, she adds—treatment. There is no cure, and symptom management requires a multidisciplinary approach, including physical therapy, exercise, and sometimes a drug called Nuedexta, whose active ingredient is detromethorphan, the same one found in cough suppressants. It suppresses other brain activities [besides coughing],” explains Dr. Gaffney, “but it’s broken down by the body too quickly to work for PBA, so a drug called quinidine is added solely to prevent the dextromethorphan from breaking down too quickly.” Sometimes low doses of antidepressants can help as well.
What’s most important is awareness, our experts agree, because PBA can be terribly isolating. Educating the caregiver and the community goes a long way, says Dr. Gupta, so that the patients and their caregivers won’t feel so alone. Here’s what you need to know when you find yourself in the role of caregiver.