![]() ![]() (1)īecause it’s not uncommon for people with ALS to have PBA, it’s standard practice for Nicholas John Maragakis, MD, a neurology professor and director of the Center for ALS Specialty Care at Johns Hopkins in Baltimore, to ask his patients questions that could signal a PBA diagnosis. There is also a scale called the Pathological Laughter and Crying Scale (PLACS), which is made up of 18 questions and is given by a healthcare professional. The Center for Neurologic Study-Lability Scale (CNS-LS) is a seven-question, self-administered (meaning the patient answers the questions) questionnaire that asks questions about laughter and crying. PBA may also be measured on a scale, based on answers to a series of questions. As in the case with many clinical diagnoses, it can be easy to miss unless the doctor has some experience with it or is looking for it, he says. “PBA is a clinical diagnosis, meaning that the clinician is basing this on the history and observation of the patient, versus a test-based diagnosis, such as a blood test or a brain scan,” says Longo. “Geriatricians and psychiatrists might diagnose the condition as well,” he adds. ( 4) Additionally, none of those people were diagnosed with pseudobulbar affect one-third of patients were diagnosed with a major depressive disorder, and 28 percent of the people were told the symptoms were part of their neurological condition.īecause it is found in many neurologic disorders, PBA is often diagnosed by neurologists, says Longo. One study revealed that among patients who discussed their laughing or crying episodes with their doctor, only 41 percent were diagnosed. PBA is often misdiagnosed or not diagnosed at all. ( 3)ĭysfunction of Neurotransmitters Theory According to this theory, the neurotransmitters serotonin, dopamine, glutamate, and sigma-1 are disrupted in various brain pathways and cause the emotional expressions to be altered. According to this theory, neurologic damage from MS or another brain disease disrupts activity in the parts of the brain related to sensory-motor and emotional processing, noted a review. Gate Control Theory By examining the brains of people with MS and PBA, researchers believe that the disorder is a result of the disinhibition of the “gate control” mechanisms that keep our expression of emotion in check. In this theory, the lesions “release” the laughter and crying center of the brain, per past research. Release Hypothesis In patients with one of the associated neurological disorders, some of the neurons in the frontal lobe that connect to the lower brain region (medulla) that controls laughter or crying are lost or damaged. ![]() There are three main theories about the brain processes involved with pseudobulbar affect: Invasive tumor in the frontal lobe involving the prefrontal cortex and subcortical structure may cause pathological laughter, and can be cured by surgery.Doctors and researchers aren’t certain what causes PBA. The pathological laughter and hemiparesis resolved within 2 weeks after surgery. The histological diagnosis was glioblastoma multiforme. Functional MR imaging showed the tumor located mainly in the prefrontal area with the posterior limit involving the premotor cortex. The hypothalamus, thalamus, internal capsule, brainstem, and cerebellum were unaffected. ![]() Cerebral magnetic resonance (MR) imaging revealed a 2.5 x 2.5 x 3 cm ring-enhanced mass in the subcortical area of the right frontal lobe associated with extensive perifocal brain edema. Her personal and social behavior was entirely appropriate except for the outbursts of laughter. The episodes of pathological laughter had become more frequent during the 3 months since the onset of hemiparesis, were elicited by non-specific, trivial stimuli, and lasted for a few minutes until she gained some control. Her face was symmetrical with intact emotional expression. Neurological examination found moderate left hemiparesis. She had no history of traumatic brain injury, or neurological or psychiatric disease, and showed no signs of drug or alcohol abuse. A 60-year-old, right-handed female presented with episodes of pathological laughter and left hemiparesis. ![]()
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