The original hypothesis for the pathophysiology underlying PBA as theorized by Wilson in 1923 was based on postmortem studies, and purported that PBA stems from lesions to the motor cortex resulting in loss of voluntary inhibition to the brainstem. Given that PBA commonly occurs in a diverse range of neurological conditions, it appears that the location of the pathology is in fact more important than the underlying pathophysiology of the primary disease process. It is believed that PBA occurs as a result of injury to the cortico-ponto-cerebellar circuitry involved in regulating the motor aspects of emotional expression. PATHOPHYSIOLOGY OF PBA The pathophysiology of PBA is complex and incompletely understood. Only articles published in English were included. Additional references were identified after reading through the 19 chosen articles and were included based on their discussion of PBA pathophysiology, prevalence, and treatment. A total of 19 articles were deemed to be relevant to this review given its focus on PBA in patients with parkinsonian disorders specifically. A literature search using the search terms “Treatment” or “SNRI” or “SSRI” or “SSRIs” or “tricyclic antidepressant” or “dextromethorphan/quinidine” or “DMQ” AND “Parkinson’s Disease” or “Parkinson” AND “Pseudobulbar affect” or “PBA” or “emotional lability” or “emotional incontinence” yielded 27 references, many of which overlapped with the prior search results. An additional PubMed search performed using the search terms “Pseudobulbar affect” or “PBA” or “emotional lability” or “emotional incontinence” AND “atypical parkinsonian disorder” or “Lewy body dementia” or “progressive supranuclear palsy” or “multiple system atrophy” or “corticobasal syndrome” yielded 4 references. A literature search using the search terms “Pseudobulbar affect” or “PBA” or “emotional lability” or “emotional incontinence” AND “Parkinson’s” or “Parkinson’s Disease” or “Parkinson” yielded a total of 48 references. METHODS References for this review were found by searching PubMed, focusing on papers published between January 1993 and March 2018. This article focuses on PBA specifically in parkinsonian disorders, examining its pathophysiology, prevalence, impact on quality of life (QoL), commonly used screening tools, and treatment options. PBA can occur in a variety of neurological conditions, including amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer’s disease (AD), stroke, traumatic brain injury (TBI) and parkinsonian disorders. Various labels have been used to describe this symptom, including emotional lability, emotional incontinence, involuntary emotional expression disorder, emotional dysregulation, emotionalism, or pathological laughter or crying. Unlike a mood disorder, which pertains to an individual’s emotional state over an extended period of time, PBA involves a deficit in regulation of emotional expression resulting in explosive and irregular emotional responses. In 1911, Hermann Oppenheim used the phrase pseudobulbar affect (PBA) to describe “explosive bursts of laughter or weeping.” Today, PBA describes a neurological symptom involving involuntary and sudden laughter or crying that is disproportionate to or incongruent with an individual’s emotional state. Keywords: Pseudobulbar affect Parkinson’s disease parkinsonism.Areas requiring further study, including the development of standardized, cross-culturally validated methods of symptom assessment, and evidence-based studies exploring the efficacy of current treatment options in parkinsonian disorders, are also highlighted. The purpose of this review is to discuss the pathophysiology of PBA, its prevalence and impact on quality of life in parkinsonian disorders, and the treatment options currently available. While indexing measures and treatment options for PBA have been extensively studied in neurological conditions such as amyotrophic lateral sclerosis and multiple sclerosis, there has been considerably less attention given in the literature to PBA in parkinsonian disorders. PBA is a socially and emotionally debilitating symptom that has been estimated to affect 3.6% to 42.5% of the population with Parkinson’s disease. Pseudobulbar affect (PBA) is a neurological symptom of inappropriate and uncontrollable laughter or crying that occurs secondary to a variety of neurological conditions, including parkinsonian disorders.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |