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Pseudobulbar Palsy

What is pseudobulbar palsy?

Highlights

  1. Pseudobulbar palsy limits your ability to control the muscles in your face.
  2. It’s usually caused by stroke, motor neuron disease, multiple sclerosis, or cerebrovascular disorders.
  3. There’s no cure for the condition. But there are treatments that may help manage symptoms.

Pseudobulbar palsy, also known as involuntary emotional expression disorder, is a condition that affects your ability to control of the muscles in your face (including your jaw). The muscles in your mouth (i.e. your tongue) and your throat can also be affected. It can have a big impact on your everyday life. And it can affect your ability to speak, eat, and swallow.

In addition to these symptoms, you may experience uncontrollable crying or laughing at inappropriate times. This is known as pseudobulbar affect or “emotional incontinence.”

Pseudobulbar palsy is common in stroke patients and those with neurological disorders such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS).

What are the symptoms of pseudobulbar palsy?

Symptoms

If you have pseudobulbar palsy, you will have trouble controlling your facial muscles, including your tongue and some muscles in your neck responsible for speaking and swallowing. You may also experience the following symptoms:

  • dysarthria, or slowed or slurred speech
  • dysphagia, or difficulty swallowing resulting in increased time required for eating and unintentional weight loss
  • dysphonia, or spasms of your vocal cord muscles producing changes in your voice
  • emotional lability, or rapid or exaggerated changes in your mood

What causes pseudobulbar palsy?

Causes

The most common causes of pseudobulbar palsy are conditions that affect the nerves that carry signals from your cerebral cortex to areas in your lower brain stem. Your cerebral cortex is a section of your brain that has many jobs. One of them is to control your motor functions (such as jumping and talking) and senses (such as vision, touch, and smell).

Your brainstem is an area of your nervous system that contains various nerves. Some are very important for controlling certain muscles like those located in your face.

When information from your cerebral cortex can’t travel to your lower brain stem, you lose the ability to fully control your face and emotional expressions.

Pseudobulbar palsy is most often linked to:

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

Who is at risk of pseudobulbar palsy?

Risk Factors

If you’ve experienced any of the following conditions, you may be at risk of developing pseudobulbar palsy:

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

How is pseudobulbar palsy diagnosed?

Diagnosis

To learn if you have pseudobulbar palsy, your doctor must examine the following:

  • facial movements
  • emotional expressiveness
  • speech

In cases where the primary symptom is emotional incontinence, pseudobulbar palsy is often misdiagnosed as major depressive disorder.

Your doctor may request imaging of your brain with an MRI in order to find the reason for your symptoms or for an underlying neurologic disease.

How is pseudobulbar palsy treated?

Treatment

There’s currently no cure for pseudobulbar palsy but your doctor may be able to treat some of your symptoms. Your doctor may recommend medication, rehabilitative therapy, lifestyle modifications including dietary modifications, as well as other therapies.

Your doctor may also prescribe treatment for the underlying cause of your pseudobulbar palsy. For example, they may prescribe treatment for stroke, dementia, or motor neuron disease.

What is the outlook for patients with pseudobulbar palsy?

Outlook

There’s currently no cure for pseudobulbar palsy, but your doctor can help you manage your symptoms. In some cases, your doctor may prescribe treatments that address the underlying cause of your symptoms.

Over time, some of your symptoms may improve. You may also experience less stress as your friends and family begin to understand your condition better. This may also help alleviate some of your symptoms.

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