As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement. 15 PD involves the malfunction and death of vital neuronal cells in the brain, primarily the substantia nigra where neurons produce dopamine, the neurotransmitter that controls movement and coordination. Like PBA, the cause of PD is unknown, although research has facilitated a better understanding of this disease. There is currently no cure, although most patients are managed with medication and/or surgery. The symptoms and degree to which one experiences these are highly individualized, but symptoms typically include tremors of the hands, arms, legs, jaw, and face bradykinesia, or slowness of movement rigidity or stiffness of the limbs and trunk and postural instability or impaired balance and coordination. 12 PD is a chronic and progressive movement disorder with symptoms that persist and worsen over time. 12 Every year in the United States, roughly 60,000 individuals are diagnosed with PD, not including the thousands who remain undiagnosed. In the United States, an estimated 1 million individuals, which is more than the combined number of patients who have been diagnosed MS or ALS, have a PD diagnosis. 6 It is a significant national health issue in the United States, occurring in greater numbers of individuals than those affected by PD, MS, or ALS alone. 1 Patients and caregivers report experiencing embarrassment and a decreased quality of life, which may lead to disruptions in their social lives, including isolation and loss of employment. PBA occurs most commonly among patients who have PD, multiple sclerosis, amyotrophic lateral sclerosis or AD or have experienced a traumatic brain injury, stroke and other neurological diseases that damage the central nervous system. 3 Unlike patients diagnosed with mood disorders, those with PBA have unsustained, explosive, and irregular emotional responses. 4 PBA is often misdiagnosed as a psychiatric disorder, such as depression, or underrecognized in patients with conditions whose symptoms mimic those of PBA. 4 These responses may also be uncharacteristic of the patient, such as excessive crying in a patient who rarely cried prior to the onset of PBA. 4,8 Patients with PBA may have an appropriate response that is more intense, recurring, and hyperbolic. 4,8-10 The patient’s laughter or crying does not always coincide with the mood or intensity of the experience the patient describes, the current social situation, or stimuli PBA may also be elicited without a stimulus. PBA has been labeled emotional lability, emotional incontinence, involuntary emotional expression disorder, emotional dysregulation, emotionalism, or pathological laughing and crying. 4,5 The behavior was described as “spasmodic explosive outbursts of laugher or weeping” and was termed “pseudobulbar affect.” 1,6 One of the oldest descriptions of pathological laughing and crying is described by French surgeon, Ambroise Paré, during the 16th century. 1 In 1886, Oppenheim and Siemerling discussed individuals with lesions along the brainstem’s descending pathways with inflated emotional behavior. 1 Pseudobulbar affect (PBA) was first recognized in the 19th century 3 however, despite being extensively described before 1940, PBA is perceived as a relatively “new” disease today. 2 Symptoms suggestive of PBA commonly occur in individuals diagnosed with Parkinson disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer disease (AD), traumatic brain injury (TBI), and stroke. 1 The causes of PBA are complex, but it is believed to result from the alteration of neuronal pathways, primarily in the frontal lobe of the brain, which control emotions. Through greater awareness, recognition, and diagnosis, treatment for patients with PBA can be improved.Pseudobulbar affect (PBA), also known as pathological laughter and crying, affects approximately 2 million Americans. The PBA Registry Series trial was created to measure the prevalence of PBA among patients with these underlying neurological conditions. PBA is thought to center around preexisting neurological conditions, which include Parkinson disease, multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer disease, traumatic brain injury, and stroke. It is characterized by uncontrollable laughing or crying that can occur in an exaggerated manner or inappropriately to a given situation or stimuli. Pseudobulbar affect (PBA), despite its prevalence and distinctive symptoms, is widely underrecognized and undertreated.
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