Pseudobulbar Palsy

Written by Heaven Stubblefield | Published on January 30, 2014
Medically Reviewed by George Krucik, MD, MBA on January 30, 2014

What Is Pseudobulbar Palsy?

Pseudobulbar palsy is an inability to control the muscles in the face. It can have a large impact on a person's ability to speak. It often results in uncontrollable crying or laughing at inappropriate times. The condition may also affect a person’s ability to swallow. In rare cases, pseudobulbar palsy also causes the limbs to twitch.

The pseudobulbar effect describes uncontrollable laughing or crying, or emotional incontinence. This is common in stroke patients and patients with neurological disorders.

Pseudobulbar palsy may also be called involuntary emotional expression disorder.

What Causes Pseudobulbar Palsy?

The most common causes of pseudobulbar palsy are diseases or conditions that affect how motor fibers carry impulses from the cerebral cortex to the lower brain stem. The cerebral cortex is the section of the brain that controls motor functions and senses. When information from the cerebral cortex cannot get to the lower brain stem correctly, a person loses his or her ability to fully control the face and emotional expression.

Pseudobulbar palsy is most often linked to stroke, motor neuron disease, multiple sclerosis, and cerebrovascular disorders.

Who Is at Risk for Pseudobulbar Palsy?

People with the following conditions may be at risk of developing pseudobulbar palsy:

  • stroke
  • motor neuron disease
  • multiple sclerosis
  • cerebrovascular disorders

Pseudobulbar palsy is sometimes misdiagnosed as major depressive disorder, so some patients thought to have severe depression may also be at risk.

What Are the Symptoms of Pseudobulbar Palsy?

Pseudobulbar palsy is characterized by the inability to control facial muscles, including the tongue. This may manifest as:

  • dysarthria (slowed or slurred speech)
  • dysphagia (difficulty swallowing)
  • dysphonia (spasms of vocal cord muscles)
  • emotional lability

How Is Pseudobulbar Palsy Diagnosed?

Pseudobulbar palsy is often misdiagnosed as major depressive disorder if its primary symptom is emotional incontinence. To determine whether pseudobulbar palsy is the cause of symptoms, a doctor must study a patient's facial movements, speech, and emotional expressiveness.

The National Stroke Association offers a test based on the Center for Neurological Study-Lability Scale that can help patients see how likely they are to have a pseudobulbar effect (National Stroke Association). This is not a substitute for medical assessment, but it may help to determine risks.

How Is Pseudobulbar Palsy Treated?

There is currently no cure for pseudobulbar palsy.

Some medications can treat specific symptoms. Medications for depression or anxiety can be used to combat involuntary emotional expression disorder.

Some medications target the underlying disorder causing the problem, such as mental disorders. If the pseudobulbar effect comes from a stroke, symptoms may fade over time or with therapy.

What Is the Outlook for Pseudobulbar Palsy?

There is currently no cure for pseudobulbar palsy, but patients can learn alternative ways to communicate with other people. Some patients may get relief through treatments that address specific medical conditions, such as dementia or motor neuron disease. As friends and family begin to understand this condition better, a patient may experience less stress as a result of pseudobulbar palsy. This may help to alleviate some symptoms.

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