The pseudobulbar affect

PBA is a symptom of MS and can present itself in episodes of uncontrollable, exaggerated, laughing and/or crying or even episodes of anger. It usually happens suddenly and often at inappropriate times.

The pseudobulbar affect (PBA) can happen without any kind of emotional trigger and is often associated with cognitive impairment and mood problems. PBA is also known as emotional lability, or emotional disinhibition, and is seen in other neurological conditions. It is thought to be caused by a lesion affecting a specific part of the brain that controls emotions – the frontal lobe. Nerve pathways are disrupted from other parts of the brain to the cerebellum, which is part of the brain that ensures emotional responses are appropriate. It is often a difficult symptom to understand and manage and can be quite distressing.

PBA can present with a person having an outburst of uncontrollable laughter, which can mask actual tears. The person may not realise that they are crying inside, yet it comes out as laughter on the surface. A person’s outward responses may not match how they feel inside. This can be misinterpreted by others around them and real emotions misunderstood.

A small study suggests that it is likely more common in women living with Secondary Progressive MS (SPMS). It appears that many people do not discuss this symptom with their multiple sclerosis (MS) team, suggesting that more awareness needs to be made.

Sometimes PBA is mistaken as depression, but both are separate symptoms of MS. PBA is distinguished from depression due to its sudden onset. It also doesn’t last long. You can have MS and depression but not experience PBA or PBA but not depression or both can be experienced together.

The symptoms of PBA respond to tricyclic and SSRI antidepressants. More commonly prescribed are citalopram or sertraline.

In many cases, the symptoms of PBA often go undetected and are therefore not treated in the right way. It may be that the person experiencing PBA doesn’t realise this is a symptom of MS, or it could be their MS team is not asking about these symptoms.

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For any advice, you can contact our helpline team free on 0800 783 0518 or via email at info@ms-uk.org.