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Handbook of Clinical Neurology 2019Pseudobulbar affect (PBA) is characterized by uncontrollable emotional episodes disconnected or disproportionate with mood, in association with an array of neurologic... (Review)
Review
Pseudobulbar affect (PBA) is characterized by uncontrollable emotional episodes disconnected or disproportionate with mood, in association with an array of neurologic conditions. PBA is associated with disruption of descending control of brainstem motor circuitry and dysregulation of serotonergic and glutamatergic function. PBA has been historically under recognized, though advances resulting in more specific diagnostic criteria, validated rating scales, and an approved pharmacotherapy offer opportunities for improved treatment outcomes.
Topics: Affective Symptoms; Brain Stem; Clinical Trials as Topic; Humans; Mood Disorders; Motor Cortex; Pseudobulbar Palsy; Psychopharmacology; Psychotropic Drugs
PubMed: 31727215
DOI: 10.1016/B978-0-444-64012-3.00014-9 -
CNS Spectrums Dec 2016Pseudobulbar affect, thought by many to be a relatively newly described condition, is in fact a very old one, described as early as the 19th century. It refers to those... (Review)
Review
Pseudobulbar affect, thought by many to be a relatively newly described condition, is in fact a very old one, described as early as the 19th century. It refers to those who experience inappropriate affect, disconnected from internal state, or mood, generally thought to be the result of an upper motor neuron injury or illness. One possible explanation for this condition's relative obscurity is the dearth of treatment options; clinical medicine is not typically in the habit of identifying conditions that cannot be modified. Now, however, there is good evidence for the treatment of pseudobulbar affect, and even a therapy approved for use by the U.S. Food and Drug Administration (FDA). As a result, appropriate identification and subsequent management of pseudobulbar affect is more important than ever. This article purports to summarize the origins of pseudobulbar affect, most current hypotheses as to its physiopathology, clinical identification, and evidence for management.
Topics: Dextromethorphan; Drug Combinations; Early Diagnosis; Excitatory Amino Acid Antagonists; Humans; Pseudobulbar Palsy; Quinidine
PubMed: 28044945
DOI: 10.1017/S1092852916000791 -
Minnesota Medicine May 1970
Topics: Adolescent; Adult; Birth Injuries; Bulbar Palsy, Progressive; Cerebrovascular Disorders; Child; Diagnosis, Differential; Endocarditis, Bacterial; Humans; Infant, Newborn; Meningoencephalitis; Middle Aged; Multiple Sclerosis
PubMed: 5419589
DOI: No ID Found -
The American Journal of Managed Care Dec 2017This activity will update pharmacists and other healthcare professionals on current treatments for pseudobulbar affect (PBA). Points of discussion will focus on the... (Review)
Review
This activity will update pharmacists and other healthcare professionals on current treatments for pseudobulbar affect (PBA). Points of discussion will focus on the off-label therapies traditionally used to treat PBA, the FDA-approved combination drug product with PBA as an indication, and managed care aspects of treating PBA.
Topics: Antidepressive Agents, Tricyclic; Drug Approval; Drug Therapy; Drugs, Investigational; Female; Humans; Male; Medication Therapy Management; Patient Safety; Pseudobulbar Palsy; Risk Assessment; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; United States; United States Food and Drug Administration
PubMed: 29297657
DOI: No ID Found -
Annals of Palliative Medicine Jul 2022The efficacy of acupuncture in the treatment of dysphagia caused by pseudobulbar paralysis after stroke is lack of evidence-based medicine. Our objective was to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The efficacy of acupuncture in the treatment of dysphagia caused by pseudobulbar paralysis after stroke is lack of evidence-based medicine. Our objective was to synthesize the efficacy of acupuncture in treating dysphagia caused by pseudobulbar paralysis after stroke.
METHODS
A comprehensive literature search was performed in 9 databases [PubMed, Web of Science, Embase, Cochrane, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese Science and Technology Periodicals database (VIP), and Open Grey online database] to screen eligible randomized controlled studies that evaluated the effect of acupuncture in dysphagia caused by pseudobulbar paralysis after stroke. The search time limit is from establishing the database to October 1, 2020. The random-effects model was used to calculate the significant effect size.
RESULTS
A total of 7 studies comprising 637 participants were included in our meta-analysis. The results showed that compared with rehabilitation, acupuncture had a significant effect on improving dysphagia caused by pseudobulbar paralysis after stroke [the significant effective size: risk ratio (RR)sig =1.51; 95% confidence interval (CI): 1.30-1.75; I2=0%]. In the subgroup analyses, the RRsig of acupuncture + rehabilitation vs. rehabilitation was 1.56 (95% CI: 1.30-1.87; I2=0%), and the RRsig of acupuncture vs. rehabilitation was 1.38 (95% CI: 1.08-1.76; I2=0.8%).
DISCUSSION
Acupuncture can be used as an effective treatment for dysphagia caused by pseudobulbar paralysis after stroke. Acupuncture combined with rehabilitation therapy has better effects.
Topics: Acupuncture Therapy; Deglutition Disorders; Evidence-Based Medicine; Humans; Pseudobulbar Palsy; Stroke
PubMed: 35400158
DOI: 10.21037/apm-21-3551 -
The Consultant Pharmacist : the Journal... Apr 2014To evaluate the role of dextromethorphan/quinidine (DM/Q; Nuedexta™) in the treatment of pseudobulbar affect (PBA). (Review)
Review
OBJECTIVE
To evaluate the role of dextromethorphan/quinidine (DM/Q; Nuedexta™) in the treatment of pseudobulbar affect (PBA).
DATA SOURCES
A literature search of MEDLINE/PubMed (January 1966-June 2013) was conducted using search terms pseudobulbar affect, pathological laughing and/or crying, emotional lability, dextromethorphan, and quinidine.
STUDY SELECTION AND DATA EXTRACTION
English language clinical trials and case reports evaluating the safety and efficacy of DM/Q in PBA were included for review. Bibliographies of all relevant articles were reviewed for additional citations.
DATA SYNTHESIS
PBA, a poorly understood disorder, is characterized by involuntary crying and/or laughing. In the past, antidepressants and antiepileptics have been used off-label with mixed results. Four clinical trials have evaluated the use of DM/Q for the treatment of PBA. Although the therapeutic outcomes with DM/Q have been positive, interpretation of the published evidence is limited by small sample size and short treatment duration.
CONCLUSIONS
Based on the data available, DM/Q may be a viable, short-term treatment alternative for PBA. Long-term safety and efficacy data are lacking.
Topics: Clinical Trials as Topic; Crying; Dextromethorphan; Drug Combinations; Excitatory Amino Acid Antagonists; Humans; Laughter; Pseudobulbar Palsy; Quinidine; Receptors, sigma; Treatment Outcome; Sigma-1 Receptor
PubMed: 24704895
DOI: 10.4140/TCP.n.2014.264 -
Deutsche Medizinische Wochenschrift... Sep 1990
Topics: Bulbar Palsy, Progressive; Humans; Nutritional Physiological Phenomena
PubMed: 2209426
DOI: No ID Found