Pseudobulbar affect (PBA) symptoms are frequent, sudden, uncontrollable outbursts of crying and/or laughing in patients with underlying neurologic conditions or brain injury1,2

RELATIVE TO MOOD, PBA EPISODES ARE1:
Exaggerated
Disproportionate to the situation and/or mood
and/or Incongruent
Inconsistent with or opposite to a person’s mood
  • Typically, crying is thought of as the physical response of shedding tears or showing sadness or distress
  • In PBA, episodes of crying are inconsistent with the underlying mood and have other hallmarks as discussed in the table below

Brain lesions that result from various neurologic diseases or injuries may disrupt the neural networks that regulate emotional expression3

NEURAL DAMAGE AFFECTS CONTROL OVER EMOTIONAL EXPRESSION3

People with PBA have a disconnect between affect (expression of emotion) and mood (inner feelings)

 

  • Pathways along the cerebral cortex, pons and other areas of the brainstem, and cerebellum (also known as the cortico-pontine-cerebellar [CPC] network) may play an important role in PBA3,4
  • One of the major neurotransmitters involved in PBA is glutamate. Glutamate receptors, including NMDA, exist in this CPC neural network in the brain3-5
 
Disruption of normal glutamate signaling along the damaged pathways may contribute to PBA episodes3
Uncovering PBA

Watch video

WATCH NURSE PRACTITIONER, CATHY YAGGI,<br class="hidden-xs"> HELP UNCOVER PBA <span class="timecode">(0:36)</span>

Uncovering PBA and associated crying

Typically, crying is thought of as the physical response of shedding tears, showing sadness, or distress. However, in PBA, the episodes of crying may appear differently, as described below.

CRYING IN PBA MAY APPEAR AS1,6-8:

Weeping with or without tears

Shedding tears noiselessly, with a sad or distressed expression or sad appearance without actual tears being produced

play
Watch Video
and/or

Inarticulate sounds

Can appear as a grunt, cry, scream, snort, wail, howl, moan, sob, snicker, or repetitive vocalizations that are inconsistent with mood

play
Watch Video
and/or

Sobbing: Combines noisy crying with loud gasps, sudden convulsions, or in-and-out movements of the chest; talking in between gasps

Wailing: Prolonged, high-pitched howling, or crying out

play
Watch Video
and/or

Facial grimacing

Twitching, gagging, and jerking the jaw, and twisting of face muscles

play
Watch Video
and/or

In addition, these episodes can be1:

  • Sudden and brief (lasting seconds or minutes)
  • Stronger and more intense than normal reactions
  • Disruptive
Symptoms and impact of PBA

Watch video

LEARN MORE ABOUT SYMPTOMS AND IMPACT OF PBA <span class="timecode">(0:49)</span>

PBA episodes follow a stereotyped pattern1:

Over time, patients or caregivers may notice similarities in initiation, length of episode, and expression of crying and/or laughing.