Pseudobulbar palsy

Pseudobulbar palsy (PBP) is a type of motor neuron disease characterized by lack of facial expressions; difficulty swallowing (dysphagia), chewing, or speaking (dysarthria); as well as emotional incontinence or the pseudobulbar affect in which the affected individual experiences uncontrollable crying and laughing. It is sometimes referred to as involuntary emotional expression disorder.

Definition & Facts

Pseudobulbar palsy affects the upper motor neurons. These are neurons that originate in the primary motor cortex which is part of the frontal lobe of the brain. These neurons communicate with the lower motor neurons located in the brainstem and spinal cord. The bulbar region consists of the pons, medulla, and brainstem and performs many involuntary functions.

Pseudobulbar palsy occurs mainly in the elderly and happens as a result of a lack of oxygen to the brain which suffocates the cells responsible for communicating with the rest of the body. There are a variety of neurological disorders that can cause this condition including brain tumors, traumatic brain injury, and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease).

Symptoms & Complaints

As a result of increased difficulty in basic jaw movements, patients lose a significant amount of weight. Patients may also experience slow or slurred speech, also known as dysarthria, and spasms or other dysfunction of the vocal cord which cause frequent voice fluctuations and tonal changes. 

In addition to experiencing many physical side effects and hardships, pseudobulbar palsy comes with its fair share of emotional side effects. People suffering from pseudobulbar palsy may experience emotional side effects of uncontrollable crying, laughing at inappropriate times, and feeling extremely strong emotions in mundane situations.

Causes

Pseudobulbar palsy is typically caused by stroke, multiple sclerosis, cerebrovascular diseases and any other type of disorder that affects the movement of neurotransmitters from the cerebral cortex portion of the brain to the lower brain stem area.

When the cerebral cortex of the brain is damaged by a stroke where regular and necessary blood flow to the brain is cut off and brain cells are being deprived of oxygen, many basic and daily functions that were once easy can become complicated, like eating and walking, and even forming basic sentences. 

When the cerebral arteries are deprived of proper amounts of oxygen to the brain, the nervous system can be affected. When the nervous system is damaged it cannot properly communicate with other parts of the body, nor does it have control over it. For this reason, the body loses control of facial muscles, basic reflexes and common functions. 

If a patient has experienced any of these diseases, physicians say that he or she is at a higher risk of becoming diagnosed with pseudobulbar palsy. 

Diagnosis & Tests

As with any condition, the diagnostic process will involve the clinician taking the patient's medical history and family history as well as conducting a physical examination.

Diagnosing pseudobulbar palsy requires a physician to analyze one’s facial movements, emotional tendencies as well as expressions, and study one’s habitual speech patterns. In regards to speech, physicians will look specifically for signs of slurring, difficulty in pronouncing simple words, and ability to speak clearly in complete sentences.

A neurological examination will be conducted to assess the patient's sensory and motor responses as well as his or her reflexes. The clinician will also seek to analyze the emotional state of the patient in order to assess whether or not they have emotional lability or emotional incontinence. The physician will also assess the individual's ability to control his or her facial movements.

In some cases a magnetic resonance imaging (MRI) is ordered to assess the structure and function of the brain. This form of neuroimaging can visualize the grey matter within the brain and identify underlying causes of pseudobulbar palsy such as tumors or lesions.

Computed tomography (CT) scans are another form of imaging that may be performed. In some cases, tests are run simply to rule out other diseases and illnesses and begin narrowing down the possibilities.

Treatment & Therapy

There is currently no definitive treatment or cure for pseudobulbar palsy; however, there are certain types of therapy that can help alleviate symptoms and bring temporary relief. Doctors may recommend certain types of medication, rehabilitative therapies, changes in diet, exercise routines, and other lifestyle changes (e.g. quitting smoking or quitting drinking) in order to assist the patient in a more rapid and full recovery.

Patients seeking full recovery may engage in occupational therapy, physical therapy and speech therapy. Psychotherapy (such as cognitive behavioral therapy) or counseling may help assist a patient in full recovery.

In addition to prescribing treatment for symptoms directly related to pseudobulbar palsy, physicians may also recommend and prescribe treatment for original causes of this disease such as stroke, other motor neuron diseases and, in rare cases, dementia. Craniectomy to remove tumorous masses may be performed. Anticoagulants and antihypertensive medications may be prescribed to reduce the risk of future stroke.

Prevention & Prophylaxis