Pseudobulbar Affect (PBA)

Collage of multiple emotions

Pseudobulbar affect is the latest name for a neurological condition also known as emotional lability, reflex crying and involuntary emotional expression disorder, among others. PBA occurs as a result of neurological diseases such as stroke, ALS, Parkinson’s, traumatic brain injury, multiple sclerosis, dementia, Wilson’s disease or brain tumors.

The frontal lobe of the brain normally keeps emotions under control. In PBA, there is a disconnect between the frontal lobe (which controls emotions) and the cerebellum and brain stem (where reflexes are mediated). The effects are uncontrollable and can occur without an emotional trigger. Those with PBA have involuntary bouts of crying, laughter or episodic anger. The outburst may be out of proportion, e.g., something slightly sad yields exaggerated weeping. On the flip side, sad or somber occasions might spur uproarious laughter. Or there could be rapid switching between laughing and crying.

PBAs have three common features. They’re involuntary, they’re brief (lasting seconds to minutes) and they’re stereotyped, meaning they have a similar appearance across disorders and within patients.

In the past, PBA has been treated with anti-depressants, although they may only be moderately successful. Ongoing research into stroke, traumatic brain injury, multiple sclerosis, Alzheimer's disease and amyotrophic lateral sclerosis (ALS) continues to increase our knowledge about PBA. If you’d like to participate in a clinical trial, go to clinicaltrials.gov to find a study near you. In the meantime, it’s always important to communicate all of your symptoms to your doctor as you work towards a treatment plan.


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