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What’s So Funny? Pseudobulbar Affect and MS

Written by Stephanie Watson | Published on October 21, 2013
Medically Reviewed by George T. Krucik, MD, MBA on October 21, 2013

MS and the Nervous System

Multiple sclerosis (MS) is a disease that damages the nervous system, which includes the brain and spinal cord. The nervous system sends messages—or signals—between the brain and body to control all of the body’s different functions. Any damage to this system can disrupt these signals.

In people with MS, damage to the central nervous system affects movement, feeling, and vision. It can also impact emotions.

Uncontrolled Emotions

Pseudobulbar affect (PBA) is a condition in which you suddenly start to laugh or cry. The reaction isn’t triggered by anything—like a funny joke or sad movie. You just burst into laughter or tears without any real cause, and you can’t stop laughing or crying. 

More than 1 million people have PBA, according to the National Stroke Association. And it usually affects people who have nervous system conditions, like MS.

MS and PBA

It’s natural to feel strong emotions when you have MS. After all, the disease can have a big effect on your life. Usually when you cry, you do it because you are upset about something. But MS damages nerves in the brain. This damage can lead to the uncontrollable crying—and laughing—of PBA. About 10 percent of people with MS have PBA, according to the National MS Society.

Emotional Incontinence

PBA is sometimes called emotional incontinence. Incontinence is a term used for people who can’t control their urine or bowel movements. People who have PBA can’t control their emotions. They start crying or laughing without meaning to. And they can’t stop the reaction, no matter how hard they try. PBA is not the same as depression or other mental illness.

All the Wrong Times

What makes PBA so hard to live with is that it can strike at all the wrong times. You might be at a funeral and start laughing out loud. Or, you may begin crying at a school music recital when everyone else is quiet. People who don’t know that you have a medical condition may not understand why you’re laughing or crying. This can be embarrassing in social situations.

Diagnosing PBA

Because it can be hard to tell PBA from other emotional problems, many people are never diagnosed. Your doctor can find out if you have PBA by asking about your symptoms. Then the doctor will go through a series of questions and assign you a score. Your score will help your doctor find out whether you have PBA. The doctor will talk to you about your score, and offer treatments for PBA if you have it.

Be Open About PBA

One of the best ways to deal with PBA is to tell your friends, co-workers, and family that you have it. Explain what PBA is and what causes it. Let the people around you know that you may have uncontrolled emotional outbursts. That way, when you suddenly burst into tears or start laughing they won’t be surprised or shocked. And you won’t have to always worry about losing control at the wrong moments.

Medicines for PBA

A few of the same medicines used to treat depression and other emotional problems can help with PBA. These include amitriptyline (Elavil), fluoxetine (Prozac), and fluvoxamine (Luvox). In 2010, the FDA approved a new drug called Nuedexta. It’s designed just for PBA in people with MS and other nervous system disorders. Nuedexta targets a chemical in the nervous system, although it’s not clear exactly how it works on PBA.

Gain Control

You can gain some control over your symptoms with a few simple tricks. When you start feeling the urge to laugh or cry, try to distract yourself. Think about something different. If you’re crying, try to focus on something upbeat or funny. For example, you could think about a funny movie you saw recently. Take slow, deep breaths. And relax the muscles that start to tense up whenever you have an episode.

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