Pseudobulbar affect prevalence in Turkish multiple sclerosis patients

Year 2018, Volume: 5 Issue: 7, 279 - 283, 30.07.2018

Serkan Demir , Asli Koskderelioglu Mustafa Karaoglan , Muhtesem Gedizlioglu Rifat Erdem Togrol

https://doi.org/10.17546/msd.441199

Abstract

Objective: Pseudobulbar affect (PBA) is characterized by uncontrolled crying or laughing attacks which are usually socially inappropriate. The estimated prevalence in patients with multiple sclerosis (MS) ranges from 10% to 46.2%. We conducted a cross-sectional study to evaluate the prevalence of PBA in the Turkish MS population. Also, we aimed to estimate whether there was gender preference or coexistent depression. Material and Methods: We used the Center for Neurologic Study - Lability Scale (CNS-LS) for this study. We included patients who were followed up at our outpatient clinic of Sultan Abdulhamid Han Education and Research Hospital with definitive diagnosis of MS at least for one year. The total number of patients was 328. 60.4% were women (198/328) and 39.6% were men (130/328). Descriptive statistical methods, student t test and chi-square tests were used for the analysis by using SPSS. The prevalence of PBA in the Turkish MS population was 39.6%. 34.6% of the men with MS had PBA; whereas 42.9% of the women with MS had PBA (p=0.132). The incidence of PBA was 48.1% in MS patients with depression and 38% in those without depression (p=0.175). Results: As a result of t-test applied it was understood that depression did not significantly contribute to PBA frequency. The average depression test score was 13.28 in non-depressed, 17.85 in others. Furthermore, there was a difference between pathological laughing and pathological crying (p<0.05). Also, in both gender pathological laughing laughter was more and the difference was significant (p<0.05). Conclusion: Our study revealed the increased frequency of PBA in MS patients. Gender and having depression did not make a significant difference on the PBA prevalence. However, depression significantly increased PBA test scores

Keywords

CNS-LS Scale, multiple sclerosis, gender

References

• 1. Schiffer R.; Pope, LE. Review of pseudobulbar affect including a novel and potential therapy. The Journal of neuropsychiatry and clinical neurosciences 2005, 17(4), 447-454.
• 2. Dark FL.; McGrath JJ.; Ron MA. Pathological laughing and crying. Aust N Z J Psychiatry 1996, 30, 472–479.
• 3. Feinstein A.; Feinstein K.; Gray T, et al. Prevalence andneurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol 1997, 54, 1116–1121.
• 4. Huffman JC; Stern TA. Poststroke neuropsychiatric symptomsand pseudoseizures: a discussion. Primary Care Companion J Clin Psychiatry 2003, 5, 85–88.
• 5. Ahmed A.; Simmons Z. Pseudobulbar affect: prevalence and management. Therapeutics and Clinical Risk Management 2013, 9, 483.
• 6. Wilson SAK. Some problems in neurology. II: Pathologicallaughing and crying. J Neurol Psychopathol 1924, IV, 299–333.
• 7. Miller A.; Pratt H.; Schiffer RB. Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments. Expert Rev Neurother. 2011, 11(7), 1077–1088.
• 8. Parvizi J.; Arciniegas DB.; Bernardini GL, et al. Diagnosis and management of pathological laughter and crying. Mayo Clin Proc 2006, 81(11), 1482–1486.
• 9. Parvizi J.; Coburn KL.; Shillcutt SD, et al. Neuroanatomy of pathological laughing and crying: a report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2009, 21(1), 75–87.
• 10. Surridge D. An investigation into some psychiatric aspects of multiple sclerosis. Br J Psychiatry 1969, 115, 749–764.
• 11. Togrol RE.; Demir S. Reliability, Validity and Validation of the CNS Emotional Lability Scale for Pseudobulbar Effect on Multiple Sclerosis in Turkish patients Psychıatry And Clınıcal Psychopharmacology (published online) https://doi.org/10.1080/24750573.2018.1472905
• 12. Vidović V.; Rovazdi MČ.; Kraml O, et al. Pseudobulbar affect in multiple sclerosis patients. Acta Clinica Croatica 2015, 54(2), 159-163.
• 13. Moore SR.; Gresham LS.; Bromberg MB, et al. A self-report measure of affective lability. J Neurol Neurosurg Psychiatry 1997, 63(1), 89–93.
• 14. Brooks BR.; Crumpacker D.; Fellus J, Kantor D.; Kaye RE. PRISM: a novel research tool to assess the prevalence of pseudobulbar affectsymptoms across neurological conditions. PLoS One 2013, 8(8), e72232.
• 15. Demler TL. Introduction to pseudobulbar affect: setting the stage for recognition and familiarity with this challenging disorder.. Am J Manag Care. 2017 ;23(18):339-44
• 16. Brooks BR.; Crumpacker D.; Fellus J, et al. PRISM: a novel research tool to assess the prevalence of pseudobulbar affect symptoms across neurological conditions. PLoS One 2013, 8:e, 72232.
• 17. Tortelli R.; Copetti M.; Arcuti S, et al. Pseudobulbar affect (PBA) in an incident ALS cohort: results from the Apulia registry (SLAP). J Neurol 2016, 263, 316–21.
• 18. Hammond FM.; Alexander DN.; Cutler AJ.; D'Amico S.; Doody RS.; Sauve W.; Zorowitz RD.; Davis CS.; Shin P.; Ledon F.; Yonan C.; Formella AE.; Siffert J. PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury. BMC Neurol, 2016 Jun 9(16), 89.
• 19. Work SS.; Colamonico JA.; Bradley WG.; Kaye RE. Pseudobulbar affect: an under-recognized and under-treated neurological disorder. Adv Ther. 2011, 28(7), 586–601.
• 20. Miller A.; Pratt H.; Schiffer RB. Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments. Expert Rev Neurother. 2011, 11(7), 1077–1088.
• 21. Pioro EP. Current concepts in the pharmacotherapy of pseudobulbar affect. Drugs 2011, 71(9), 1193–1207.
• 22. Robinson RG.; Parikh RM.; Lipsey JR.; Starkstein SE.; Price TR. Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychiatry 1993, 150(2), 286–293.
• 23. Schiffer RB.; Herndon RM.; Rudick RA. Treatment of pathologic laughing and weeping with amitriptyline. N Engl J Med 1985, 312(23), 1480–1482.