Title : What will audience learn from your presentation? • This case report will also present a review of recent literature revolving around PBA which will help other physicians and professionals understand and further include PBA as a diagnosis when assessing a patient demonstrating involuntary episodes of laughing and crying status-post a traumatic brai
Pseudobulbar affect (PBA), previously known as Pathologic Laughing and Crying (PLC) is a neurological disorder characterised by involuntary episodes of emotional expression, such as laughing or crying, that are disproportionate to the individual's current emotional state. Though the etiology and pathophysiology of PBA is not fully understood, it is said to be the result of damage to the neural pathways involved in emotional regulation, particularly the corticobulbar and corticospinal tracts. The severity and frequency of PBA episodes can vary widely between individuals, and may be influenced by the underlying neurological conditions. It is estimated that up to two million Americans have PBA. PBA can occur in a variety of neurological conditions, including traumatic brain injury (TBI), multiple sclerosis, stroke, amyotrophic lateral sclerosis (ALS) and Alzheimer's disease. Epidemiology studies show that 5.3% to 48.2% of people with TBI may have symptoms consistent with (or suggestive of) PBA. Despite its prevalence, PBA is often under-recognised and under-treated, leading to significant impairments in patients' quality of life. The diagnosis of PBA is purely clinical, based on a careful history and physical, and the exclusion of other potential causes of emotional dysregulation, such as depression or anxiety. PBA can be confused with various mood disorders due to the overlap in symptoms and sequelae that follow TBIs. Several screening tools have been developed to aid in the diagnosis of PBA, such as the Center for Neurologic Study-Liability Scale and the Pathological Laughter and Crying Scale. Many pharmacological treatments can be used in PBA including dextrometrophan/quinidine, amitriptyline and Selective Serotonin Reuptake Inhibitors (SSRIs). Non-pharmacological interventions such as psychotherapy, speech therapy, and Cognitive-Behavioral Therapy (CBT), may also be effective in managing PBA, particularly when used in conjunction with pharmacological interventions; We present a case report of a 57-year-old female with a history of TBI, Post Traumatic Stress Disorder (PTSD) and Post Concussive Syndrome (PCS) who presents with paroyxsms of episodes involving laughing followed by crying. Her episodes have been existent for more than a year. She endorses having a depressed mood, fatigue and poor concentration. Though the patient has been demonstrating these symptoms for more than a year, she was not assessed for PBA until recently. The patient is now part of a study involving Low-level laser therapy (LLLT) for her TBI and is currently taking antidepressants as well.
Audience Take Away
- This case report will also present a review of recent literature revolving around PBA which will help
other physicians and professionals understand and further include PBA as a diagnosis when assessing a patient demonstrating involuntary episodes of laughing and crying status-post a traumatic brain injury. This current patient was presumed of having seizures when the reality was, she was having episodes of PBA
- The audience will be taught to differentiate PBA from many different mood disorders such as depression, bipolar disorder, manic episodes and from many neurological disorders such as strokes, seizures, frontotemporal dementia etc. They will be taught the correct screening tools to use during a patient encounter such as the Pathological Laughing and Crying Scale and the center for Neurologic Study-Liability Scale. Presenting various screening methods allows the physician/professional to help narrow a diagnosis towards PBA rather than only basing the diagnosis from the history and physical. It also shows that there are targeted screening methods towards PBA as well
- This showcases the different pharmacological treatments used to treat PBA such as Dextromethorphan/Quinidine which was recently approved by the United States Food and Drug Administration (FDA) for the treatment of PBA and its ability to reduce the frequency and severity of PBA episodes