Bulbar palsy refers to weakness of certain facial muscles. Pseudobulbar palsy is a set of symptoms that resemble bulbar palsy, but has a different cause, some unique symptoms, and requires different treatment approaches.

Bulbar palsy is a general term doctors use to describe weakness of the bulbar muscles, a group of muscles in your face and mouth. This may impair your speech, facial movements, and ability to swallow.

Pseudobulbar palsy is a distinct set of symptoms. Scientists coined the term in 1877 to distinguish it from bulbar palsy because it had some of the same symptoms. (“Pseudo” means “fake.”) The term may not be very accurate, as the two are due to different affected areas of the brain.

Keep reading to learn more about how these two terms differ.

Although motor neuron disease, which may lead to pseudobulbar palsy or bulbar palsy, may affect children or adults, symptoms usually begin after age 50.

Pseudobulbar and bulbar palsy share some of the following symptoms:

Pseudobulbar palsy, also known as involuntary emotional expression disorder, also has some of the following symptoms:

The symptoms of bulbar palsy may include:

  • weakness in your tongue
  • lack of a gag reflex
  • involuntary jerking of your jaw muscles

Bulbar palsy may be progressive, where the symptoms get worse over time, or it may be non-progressive.

Progressive bulbar palsy

While bulbar palsy is a symptom, you may also hear the term “progressive bulbar palsy,” which is a condition.

Progressive bulbar palsy is a form of motor neuron disease similar to amyotrophic lateral sclerosis (ALS), aka Lou Gehrig’s disease. About 25% of ALS cases are bulbar onset. Most cases are limb onset, where the symptoms begin in your arms or legs.

In children and young adults, progressive bulbar palsy may lead to Fazio Londe syndrome, a rare but treatable condition with additional symptoms, including difficulty breathing and hearing loss.

Pseudobulbar palsy and bulbar palsy both result from the deterioration of some of the cranial nerves that send signals from your cerebral cortex (outer layer of your brain) to your lower brain stem.

This nerve damage affects your ability to control the muscle movement in your face and mouth.

Damage to the upper motor neurons in your brain and spinal cord causes pseudobulbar palsy.

On the other hand, damage to the lower motor neurons in your peripheral motor nerves causes bulbar palsy.

To diagnose pseudobulbar or bulbar palsy, a doctor will ask about your medical history and perform a physical exam. During this exam, the doctor will check your:

  • ability to control your facial muscles
  • emotional expressiveness
  • speech

Based on the results of your physical exam, a doctor may recommend some of the following procedures:

If you think you may have pseudobulbar palsy, be sure to tell a doctor if you are experiencing uncontrolled emotional outbursts. PBA is commonly misdiagnosed as some of the following conditions:

There’s no cure for either pseudobulbar or bulbar palsy, but you can manage these symptoms with treatment.

Rehabilitative therapy, such as physical and speech therapy, may help you perform everyday activities and improve your quality of life.

A doctor may treat bulbar palsy as follows:

  • prescribe anticholinergic drugs, such as benztropine mesylate (Cogentin) or oxybutynin (Ditropan XL), to help prevent drooling
  • prescribe riluzole (Rilutek) to help reduce some nerve damage and respiratory symptoms
  • perform a gastrostomy by inserting a feeding tube into your stomach to help improve your digestion of nutrients (if the disease progresses)

Note that the FDA has approved riluzole to treat ALS only.

For pseudobulbar palsy, a doctor may prescribe:

How long you experience pseudobulbar and bulbar palsy depends on the underlying cause. For example, if pseudobulbar palsy is due to a stroke, your symptoms may improve over time.

But if your symptoms are due to a progressive disorder, they may slowly worsen.

Progressive bulbar palsy is usually fatal due to respiratory failure, which may occur within 10 years of when the symptoms first began.

Although they’re not the same neurological condition, there’s no cure for either pseudobulbar or bulbar palsy.

However, medications and rehabilitative therapy may help you manage the symptoms and improve your quality of life.