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Wednesday, January 21, 2015

Emotional Incontinence: Pseudobulbar Affect

"Emotional Incontinence."

An interesting, descriptive term to explain one of the more newly recognized effects of multiple sclerosis on the emotions, or pseudobulbar affect (PBA.)

When we think of incontinence, we think of the inability to control the bowel and bladder. With PBA, the "incontinence" is emotional. This is an issue for up to one million people worldwide, according to the American Stroke Association. This syndrome can be caused by several neurological conditions, including MS.

The syndrome involves the inappropriate, uncontrollable outburst of emotion, whether happy or sad. For example, an individual might be attending a funeral, and begins uncontrollably laughing at this sad occasion. Likewise, an individual may find themselves crying hysterically at a birthday party, for no apparent reason. This display of emotion is not explainable typically, and does not relate to any actual events. It is unpredictable, can occur at any time during the day, and is utterly uncontrollable by the individual experiencing it.

Fortunately, we have begun to recognize this disorder, and treat it more appropriately. There are now several approved medications to treat this symptom, including Elavil, Prozac, Luvox, and the newly approved drug Nuedexta. This is a treatable symptom, and is not related to depression, anxiety, or any other psychological illness or disturbance.

The characteristics of depression and PBA are very different, and easy to distinguish
Source: Cummings, 2007

If you find yourself experiencing these symptoms, please speak to your provider, and know that you are not alone. Like all MS related symptoms, this is directly caused by lesions affecting emotional centers of the brain, and it does not indicate that you are "crazy," or mentally ill.

One of the most difficult aspects of MS is the ever evolving, sometimes bizarre and unclear symptoms that patients experience. We often find ourselves asking, "is this MS?" It is important to understand that MS can manifest as almost any physical, emotional, or psychological symptom, depending on the specific area of the brain that has suffered damage. As we know, the brain is the "CEO" of the entire body, and controls absolutely every bodily function. We also understand that MS is capable of causing attacks and damage to absolutely every area of the brain. Individual disease courses can be so diverse, and one individual may have primarily emotional manifestations of the disease, while another may experience purely physical decline. Please do not ever feel like you are imagining your symptoms. If in doubt, check in with your provider.
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