There are several conditions that affect around 5 million Americans in any given year – including Alzheimer’s, fibromyalgia, heart failure and psoriasis. But there’s another condition, just as prevalent, that is much less known: pseudobulbar affect (PBA) – a neurologic condition that results in involuntary and uncontrollable outbursts of crying or laughing.
If you have heard of it, it’s likely because it has affected you or a loved one, or because you have seen the commercials with actor and director Danny Glover, who has partnered with Avanir Pharmaceuticals in a campaign to educate patients and caregivers about PBA.
Liana Urfer, a Vero Beach psychiatrist, sees the campaign as a good thing.
She says “it will increase knowledge about PBA for both patients and physicians, which will lead to it being correctly diagnosed and correctly treated more often than it is now.”
PBA is caused by damage in the areas of the brain that control the expression of emotion; this damage disrupts the brain’s signaling processes, in effect causing a short circuit. Strokes are a common cause of the condition and up to half of all stoke survivors experience it at some time.
Other neurological causes of PBA are amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s and Alzheimer’s. (A team of clinicians affiliated with from Brookdale University Hospital and Medical Center in Brooklyn recently screened 80 nursing home residents and determined that symptoms of PBA were present in nearly 45 percent of patients diagnosed with Alzheimer’s and other forms of dementia.)
A traumatic brain injury can also lead to PBA. In 2015, football Hall of Famer Barry Sanders went public to raise awareness about some of the serious, long-term neurological problems – including PBA – that can occur from playing football and other contact sports. Speaking of retired NFL players, Sanders said, “Well over 90 percent of those guys have had a head injury when they played, and a third of those guys are suffering from PBA-like symptoms, so we’re just getting the word out that they should visit a doctor.”
In PBA, the outbursts of laughing or crying are often inappropriate to the situation, like laughing when a friend shares a serious story, or crying during a funny movie. And if the emotion is appropriate, the eruptions can be more intense or of longer duration than warranted by the situation.
Because crying episodes are more common in PBA than are eruptions of laughter, the sufferer may mistake the condition for depression. But depression is fundamentally different: It’s a continuous state of sadness or hopelessness that can last for weeks, months or years, while the episodes characteristic of PBA are relatively brief, and most often don’t reflect how the person is actually feeling. However, PBA and depression can co-exist in the same person, so it’s important that each condition be diagnosed and treated separately.
Dr. Urfer says that the most frequent misdiagnosis is bipolar disorder, because PBA seems to show severe mood fluctuations. In addition to bipolar disorder and depression, PBA can be mistaken for or misdiagnosed as generalized anxiety disorder, schizophrenia or even epilepsy. It can also go completely undiagnosed, due to a general lack of awareness about the condition.
Based on their symptoms, patients suffering from PBA may first seek help from a psychiatrist; Dr. Urfer says this specialty is well able to recognize the condition. For a formal diagnosis, a thorough neurological examination is needed, consisting of a series of simple questions and noninvasive tests that provide crucial information about the nervous system.
Once diagnosed, the goal of treatment is to reduce the severity and frequency of outbursts. Although PBA has been recognized in medical literature for over 100 years, the first and only drug specifically designed to treat it was approved by the FDA fairly recently, in 2010. The drug – Nuedexta – is manufactured and marketed by Avanir, the pharmaceutical company that sponsors the Danny Glover PBA awareness campaign. According to the Mayo Clinic, a study of people with MS or ALS showed that those taking Nuedexta had about 50 percent fewer laughing and crying episodes than those taking a placebo.
Although PBA is not depression, antidepressants are sometimes prescribed to treat it, typically at doses lower than are used in the treatment of depression. Some people with PBA find working with an occupational therapist helpful, as they can develop ways to better complete everyday tasks despite frequent episodes caused by the condition.
Dr. Urfer says “an increased awareness of PBA will help to destigmatize it, and even more importantly, will let sufferers know that it is treatable.”
Dr. Urfer’s practice is located at 641 17th Ave in Vero Beach; the office phone is 772-978-9793.