PseudoBulbar Affect (PBA) and Parkinson's

Reviewed by: HU Medical Review Board | Last reviewed: March 2018

PseudoBulbar Affect (PBA) is a condition that can occur in people with a variety of neurological conditions, including Parkinson's disease (PD). PBA is characterized by sudden, uncontrollable outbursts of crying or laughing, and it is believed to develop when the underlying neurological disease affects areas of the brain related to emotion.

What causes PBA?

In people with PBA, the involuntary emotional responses do not match the person’s feelings, and the outbursts can be intense, can happen multiple times throughout the day, and they may occur during inappropriate times.1

In people with PD, PBA may occur as levodopa medication is wearing off. PBA may also be triggered by deep brain stimulation (DBS), a surgical technique in which a device is implanted in the person to deliver electrical pulses to the brain to decrease motor symptoms of PD.2

Besides PD, other neurological conditions that are associated with PBA include traumatic brain injury, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer's disease, stroke, and brain tumors.1

How can it affect quality of life?

PBA can have a significant impact on a person's social life. The emotional outbursts caused by PBA may cause a person to laugh during a serious event or start sobbing when they are actually happy.

While the episodes are generally brief, they can happen frequently and can impair a person's ability to communicate effectively. The unpredictable and inappropriate outbursts can make it difficult and embarrassing for people with PBA to engage in social situations, and some people with PBA become withdrawn and may suffer from social isolation.3

What is the link to mood disorders?

While it may be confused with depression or bipolar disorder, PBA is a separate condition. However, researchers have found that people with PBA tend to have higher rates of anxiety and other psychiatric disorders.

Approximately 30%-35% of people with PBA have depression. While depression can also cause crying episodes, the crying seen with PBA is generally of a shorter duration, compared to weeks or months of crying seen in depression.1

How is it diagnosed?

PBA is most often diagnosed based on reports from the patient or their caregiver. The following characteristics may be indicative of PBA:1

  • The emotional response is inappropriate to the situation
  • The individual's feelings do not match the emotional outburst
  • The duration and severity of the emotional response cannot be controlled by the person
  • The expression of emotion does not provide a feeling of relief
  • The emotional response isn't dependent on a stimulus, or it is an exaggerated response to a stimulus
  • The emotional outbursts cause significant distress or impact the person's social life

If you think someone you love might have PBA, take note of when and how often the outbursts occur, as well as what was happening at the time of the outburst (this can help demonstrate that the episode occurred during an inappropriate time).

How is it treated?

There is treatment available that can help reduce the emotional outbursts of PBA. Nuedexta® (dextromethorphan HBr and quinidine sulfate) has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of PBA. Nuedexta combines two medications in one pill and has demonstrated effectiveness in reducing PBA episodes in clinical trials.

The reduction increased as patients stayed on the drug longer, with an average 44% reduction seen in the first week of treatment and an average 82% reduction seen after 12 weeks of treatment. The most common side effects experienced by people taking Nuedexta include diarrhea, dizziness, cough, vomiting, weakness, swelling of the feet or ankles, urinary tract infection, flu, and flatulence (gas).4

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