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Journal of Neurology, Neurosurgery, and... Oct 2017Pseudobulbar affect (PBA) is prevalent in amyotrophic lateral sclerosis (ALS), but there is limited information on its associations and course. (Observational Study)
Observational Study
BACKGROUND
Pseudobulbar affect (PBA) is prevalent in amyotrophic lateral sclerosis (ALS), but there is limited information on its associations and course.
OBJECTIVES
Explore prevalence, associations, course and manifestations of PBA in outpatient cohort of patients with ALS and examine its relationship to depression.
METHODS
Self-reported measures of PBA and depression (Center for Neurologic Study-Lability Scale (CNS-LS) and Patient Health Questionnaire (PHQ-9), respectively) were obtained from consecutive patients with ALS using tablet devices in waiting rooms (Knowledge Program).
RESULTS
PBA (CNS-LS ≥13) was seen in 209/735 patients (28.4%). PBA was associated with bulbar onset and dysfunction, upper motor neuron dysfunction, cognitive impairment, depression and lower quality of life. A multivariable model that included lower bulbar and gross motor subscores, female gender, younger age and shorter duration of disease predicted PBA with 74% accuracy. CNS-LS scores increased only slowly with time. Women with PBA reported more crying than men. Crying (but not laughter) correlated with depression, and crying was associated with poorer quality of life. Exploratory factor analysis of pooled questions of CNS-LS and PHQ-9 identified three underlying factors (laughter, crying and depression) loaded on appropriate questions of the respective instruments.
CONCLUSION
This study identifies associations of PBA and additionally finds PBA (especially crying-predominant PBA) more prevalent in women with ALS. Although the two self-report instruments (CNS-LS and PHQ-9) discriminate well between PBA and depression, there is significant overlap between depression and crying in PBA. Studies of PBA should stratify for gender, examine crying and laughter as separate outcomes and adjust for depression.
Topics: Age Factors; Amyotrophic Lateral Sclerosis; Crying; Depression; Female; Humans; Laughter; Male; Middle Aged; Prevalence; Pseudobulbar Palsy; Quality of Life; Sex Factors; Surveys and Questionnaires
PubMed: 28572273
DOI: 10.1136/jnnp-2017-315622 -
Contemporary Nurse Aug 2022Pseudobulbar affect (PBA) has recently been added to the list of mental disorders commonly observed in patients with Multiple Sclerosis (MS). The emotional changes...
BACKGROUND
Pseudobulbar affect (PBA) has recently been added to the list of mental disorders commonly observed in patients with Multiple Sclerosis (MS). The emotional changes experienced by MS patients may be associated with other mental problems and adversely affect disease prognosis. However, there are limited studies in the international and national literature on this subject.
AIM
This study aimed to evaluate the relationship between PBA and stress, anxiety, and depression levels in patients with MS.
DESIGN
This is a descriptive, relational, and cross-sectional study.
METHODS
A total of 442 MS patients followed in the neurology outpatient clinic of a hospital and registered with the MS Society in Turkey participated in this study. Data were collected using a personal information form, the Turkish version of the Center for Neurologic Study-Lability Scale (CNS-LS), and the Depression Anxiety Stress Scale (DASS).
RESULTS
In this study, 63.3% of the patients had PBA, 21% had extremely severe depression, 41.6% had extremely severe anxiety, and 24.9% had severe stress. Correlation analysis revealed weak positive correlations between CNS-LS total score and DASS subscale and total scores. Depression, anxiety, and stress levels accounted for 22.5% of the variation in CNS-LS total score.
CONCLUSION
The results of this study indicate that a majority of MS patients in Turkey experience PBA, depression, anxiety, and stress, and that PBA is positively associated with depression, anxiety, and stress.
IMPACT STATEMENT
This study, indicates that should be increased consultation-liaison psychiatry services in Turkey, and MS patients should benefit from comprehensive psychiatric services.
Topics: Humans; Pseudobulbar Palsy; Multiple Sclerosis; Cross-Sectional Studies; Depression; Anxiety
PubMed: 35880717
DOI: 10.1080/10376178.2022.2107037 -
Journal of Neurology, Neurosurgery, and... Jun 2004We describe a case of pseudobulbar crying associated with deep brain stimulation (DBS) in the region of the subthalamic nucleus (STN). Patients with pseudobulbar crying...
We describe a case of pseudobulbar crying associated with deep brain stimulation (DBS) in the region of the subthalamic nucleus (STN). Patients with pseudobulbar crying show no other evidence of subjective feelings of depression such as dysphoria, anhedonia, or vegetative signs. This may be accompanied by other symptoms of pseudobulbar palsy and has been reported to occur with ischaemic or structural lesions in both cortical and subcortical regions of the brain. Although depression has been observed to result from DBS in the region of the STN, pseudobulbar crying has not been reported. A single patient who reported the symptoms of pseudobulbar crying after placement of an STN DBS was tested in the off DBS and on DBS conditions. The patient was tested using all four DBS lead contacts and the observations and results of the examiners were recorded. The Geriatric Depression Scale was used to evaluate for depression in all of the conditions. The patient exhibited pseudobulbar crying when on monopolar stimulation at all four lead contacts. The pseudobulbar crying resolved off stimulation. This case describes another type of affective change that may be associated with stimulation in the region of or within the STN. Clinicians should be aware of this potential complication, the importance of differentiating it from stimulation induced depression, and its response to a serotonin reuptake inhibitor, such as sertraline.
Topics: Crying; Depressive Disorder; Electric Stimulation Therapy; Female; Geriatric Assessment; Humans; Magnetic Resonance Imaging; Middle Aged; Parkinson Disease; Pseudobulbar Palsy; Subthalamic Nucleus
PubMed: 15146017
DOI: 10.1136/jnnp.2003.016485 -
The Canadian Journal of Neurological... Jul 2018
Topics: Anterior Temporal Lobectomy; Epilepsy; Female; Humans; Magnetic Resonance Imaging; Meningioma; Postoperative Complications; Pseudobulbar Palsy; Skull Base Neoplasms
PubMed: 29747704
DOI: 10.1017/cjn.2018.26 -
Experimental and Therapeutic Medicine Oct 2017The present study aimed to investigate the efficacy of endoscopy in the treatment of post-shunt placement for slit ventricle syndrome (SVS). Endoscopic surgery was...
The present study aimed to investigate the efficacy of endoscopy in the treatment of post-shunt placement for slit ventricle syndrome (SVS). Endoscopic surgery was performed on 18 patients with SVS between October 2004 and December 2012. Sex, age, causes of the hydrocephalus, ventricular size and imaging data were collected and analyzed. All patients were divided into two groups according to ventricular size and underwent endoscopic surgeries, including endoscopic third ventriculostomy (ETV), endoscopic aqueductoplasty and cystocisternostomy. All treated patients were observed postoperatively for a period of 2 to 3 weeks, and outpatient follow-up was subsequently scheduled for >12 months. Clinical results, including catheter adherence, shunt removal and complications, were analyzed during the follow-up period. The success rate of endoscopic surgery was indicated to be 82.7%. Syndromes caused by aqueductal stenosis in 15 patients who underwent ETV were relieved; however, syndromes in the 3 patients with cerebral cysticercosis, suprasellar arachnoid cysts, pinea larea glioma and communicating hydrocephalus, respectively, were not relieved and underwent shunt placement again. Brain parenchyma, choroid plexus and ependymal tissue were the predominant causes for catheter obstruction and the obstruction rate was indicated to be 77.8% (14/18). Complications, such as pseudobulbar paralysis, infection and intraventricular hemorrhage arose in 3 patients. The present study indicates that endoscopic treatments are effective and ETV may be considered as a recommended option in the treatment of post-shunt placement SVS in hydrocephalus patients.
PubMed: 29042922
DOI: 10.3892/etm.2017.4973 -
The Neurologist Nov 2007The rate of depression and other psychiatric disorders is greater in multiple sclerosis (MS) than in other chronic conditions or neurologic diseases. This means that... (Review)
Review
BACKGROUND
The rate of depression and other psychiatric disorders is greater in multiple sclerosis (MS) than in other chronic conditions or neurologic diseases. This means that clinical neurologists seeing MS patients will frequently be engaged in the diagnosis and treatment of psychiatric distress.
REVIEW SUMMARY
This review provides a summary of what is known about psychiatric dysfunction in MS. It offers information about the current views on the link between various psychiatric disorders and MS. More important, it offers suggestions on how the knowledge from existing research can be integrated into real-world practice.
CONCLUSION
Clinicians need to understand the factors that influence the development of psychiatric disorders in MS, the relationship between disease-modifying therapies and psychiatric distress, and the issues surrounding the treatment of psychiatric conditions in MS. Thorough knowledge of psychiatric dysfunction and MS will allow the clinician to design an effective treatment regimen that helps patients cope with their disease.
Topics: Bipolar Disorder; Brain; Cholinergic Antagonists; Comorbidity; Depressive Disorder; Humans; Immunosuppressive Agents; Multiple Sclerosis; Neurocognitive Disorders; Pseudobulbar Palsy; Stress, Psychological
PubMed: 18090712
DOI: 10.1097/NRL.0b013e31806dc2e8 -
Actas Dermo-sifiliograficas Mar 1946
Topics: Humans; Pseudobulbar Palsy
PubMed: 20984644
DOI: No ID Found -
Age and Ageing Aug 1977In the past four years, four patients with progressive supranuclear palsy have presented to the Department of Geriatric Medicine, Oxford, under the care of one of us...
In the past four years, four patients with progressive supranuclear palsy have presented to the Department of Geriatric Medicine, Oxford, under the care of one of us (RAG). They were all females whose symptoms began in the sixth or seventh decade. They died from three to six years after the onset of symptoms. All had neuropathological studies which are described. The presenting characteristics included frequent falls, difficulty in walking, nuchal rigidity, abnormalities of gaze, pseudobulbar features and mild dementia. These are features particularly common in the elderly and it is suggested that the condition may be under-diagnosed.
Topics: Aged; Brain; Bulbar Palsy, Progressive; Dementia; Female; Humans; Middle Aged; Neurologic Examination; Ophthalmoplegia; Paralysis; Syndrome
PubMed: 899968
DOI: 10.1093/ageing/6.3.185 -
Dysphagia 1994The potential causes of neurogenic oropharyngeal dysphagia in cases in which the underlying neurologic disorder is not readily apparent are discussed. The most common... (Review)
Review
The potential causes of neurogenic oropharyngeal dysphagia in cases in which the underlying neurologic disorder is not readily apparent are discussed. The most common basis for unexplained neurogenic dysphagia may be cerebrovascular disease in the form of either confluent periventricular infarcts or small, discrete brainstem stroke, which may be invisible by magnetic resonance imaging. The diagnosis of occult stroke causing pharyngeal dysphagia should not be overlooked, because this diagnosis carries important treatment implications. Motor neuron disease producing bulbar palsy, pseudobulbar palsy, or a combination of the two can present as gradually progressive dysphagia and dysarthria with little if any limb involvement. Myopathies, especially polymyositis, and myasthenia gravis are potentially treatable disorders that must be considered. A variety of medications may cause or exacerbate neurogenic dysphagia. Psychiatric disorders can masquerade as swallowing apraxia. The basis for unexplained neurogenic dysphagia can best be elucidated by methodical evaluation including careful history, neurologic examination, videofluoroscopy of swallowing, blood studies (CBC, chemistry panel, creatine kinase, B12, thyroid screening, and anti-acetylcholine receptor antibodies), electromyography, and magnetic resonance imaging (MRI) of the brain, plus additional procedures such as lumbar puncture and muscle biopsy as indicated. Little is known about aging and neurogenic dysphagia, specifically the relative contributions of natural age-related changes in the oropharynx and of diseases of the elderly, including periventricular MRI abnormalities, in producing dysphagia symptoms and videofluoroscopic abnormalities in this population.
Topics: Age Factors; Aging; Brain; Brain Diseases; Deglutition Disorders; Fluoroscopy; Head and Neck Neoplasms; Humans; Infections; Muscular Dystrophies; Neuromuscular Diseases; Oropharynx; Videotape Recording; Vitamin B 12 Deficiency
PubMed: 7805424
DOI: 10.1007/BF00301918 -
Journal of Palliative Medicine Mar 2016
Topics: Amyotrophic Lateral Sclerosis; Depression; Dyspnea; Guidelines as Topic; Humans; Muscle Spasticity; Pain; Pseudobulbar Palsy; Riluzole
PubMed: 26828305
DOI: 10.1089/jpm.2015.0362