Understanding Pseudobulbar Affect in Patients Caused by Multiple Sclerosis

(BPT) - This article is sponsored by Otsuka America Pharmaceutical, Inc., for which Dr. Mayer Joshua Hasbani is a paid consultant.

This March is Multiple Sclerosis (MS) Awareness Month and an appropriate time to shine a light on a common neurological condition called Pseudobulbar Affect, otherwise known as PBA¹. MS is a chronic and often debilitating disease affecting nearly one million individuals in the U.S.² PBA can impact some patients within the MS community, yet is frequently misunderstood and underdiagnosed³.

“Pseudobulbar Affect or PBA is characterized by uncontrollable laughing, crying, or a combination of both, and has been reported in an estimated 10 to 46 percent of patients with MS. These symptoms are involuntary, exaggerated, often sudden, and do not necessarily align with the individual’s actual feelings,” according to Dr. Mayer Joshua Hasbani, Board Certified Neurologist, Hasbani Neurology. “PBA is thought to stem from neurological changes caused by MS, that is different from emotional disorders like depression, which PBA is often confused for, so it is increasingly important to understand, recognize and diagnose those affected.”

Because PBA symptoms can be mistaken for emotional disorders like depression, this can lead to misdiagnosis¹. As a result, people experiencing PBA may struggle with their symptoms before finally receiving an accurate diagnosis¹. Therefore, differentiating PBA from conditions like depression is important since each requires a unique approach to care.

“PBA can present a considerable burden in addition to the struggles of living with MS. This is further compounded by a lack of awareness and understanding about PBA that extends beyond healthcare providers to the general public. As a result, many individuals with PBA and those around them may experience frustration when episodes occur, as the episodes can be misunderstood and lead to confusion and embarrassment,” says Dr. Hasbani. “Therefore, patients with MS who are experiencing PBA-like symptoms of uncontrollable laughing, crying, or a combination of both, or their caregivers and loved ones, should talk to their healthcare provider about potential treatment options available.”

Today, NUEDEXTA^® (dextromethorphan HBr and quinidine sulfate) is currently the only FDA-approved treatment for PBA and is clinically proven to reduce PBA episodes. Do not take NUEDEXTA if you are taking other drugs that contain quinidine, quinine, or mefloquine. The most common side effects were diarrhea and dizziness. These are not all the risks from use of NUEDEXTA. Please see additional Important Safety Information below.

“Having the ability to diagnose and treat my patients experiencing uncontrollable crying and laughter is especially rewarding,” says Dr. Hasbani. “While there is no cure for PBA and a diagnosis may seem daunting for patients, treatment with NUEDEXTA is an option that can help appropriate patients decrease laughing and/or crying episodes.”

Patients with MS who experience symptoms of PBA should engage in an open dialogue with their healthcare providers⁴ or seek consultation with a neurologist that has experience treating individuals with PBA. Specifically, sharing details about the frequency, nature, and impact of laughing or crying episodes can greatly assist a healthcare provider in making an accurate diagnosis and determining proper treatment⁴. Effectively managing PBA caused by MS needs a holistic approach to communication and a thorough care plan.

For more information about PBA, NUEDEXTA^®, and resources for support and education, please visit treatingPBA.com. Please read the full INDICATION and IMPORTANT SAFETY INFORMATION for NUEDEXTA below.

INDICATION and IMPORTANT SAFETY INFORMATION for NUEDEXTA^® (dextromethorphan HBr and quinidine sulfate)

INDICATION:

NUEDEXTA is approved for the treatment of Pseudobulbar Affect (PBA).

PBA is a medical condition that causes involuntary, sudden, and frequent episodes of crying and/or laughing in people living with certain neurologic conditions or brain injury. PBA episodes are typically exaggerated or don’t match how the person feels. PBA is distinct and different from other types of emotional changes caused by neurologic disease or injury.

NUEDEXTA is only available by prescription.

IMPORTANT SAFETY INFORMATION:

Before you take NUEDEXTA, tell your doctor:

• If you are taking monoamine oxidase inhibitors (MAOIs), quinidine, or quinidine-related drugs. These can interact with NUEDEXTA causing serious side effects. MAOIs cannot be taken within 14 days before or after taking NUEDEXTA.
• If you have previously had an allergic reaction to dextromethorphan, quinidine or quinidine-like drugs.
• About all medicines, herbal supplements, and vitamins you take as NUEDEXTA and certain other medicines can interact causing side effects.
• If you have had heart disease or have a family history of heart rhythm problems. NUEDEXTA may cause serious side effects, including changes in heart rhythm. If you have certain heart problems, NUEDEXTA may not be right for you. Your doctor may test your heart rhythm (heartbeats) before you start NUEDEXTA.
• If you have myasthenia gravis.

While taking NUEDEXTA, call your doctor right away:

• If you feel faint or lose consciousness.
• If you experience lightheadedness, chills, fever, nausea, or vomiting as these may be signs of an allergic reaction to NUEDEXTA. Hepatitis has been seen in patients taking quinidine, an ingredient in NUEDEXTA.
• If you have unexplained bleeding or bruising. Quinidine, an ingredient in NUEDEXTA, can cause a reduction in the number of platelets in your blood which can be severe and, if left untreated, can be fatal.
• If you feel dizzy, since it may increase your risk of falling.
• If you have muscle twitching, confusion, high blood pressure, fever, restlessness, sweating, or shivering, as these may be signs of a potential drug interaction called serotonin syndrome.

The most common side effects of NUEDEXTA include: diarrhea, dizziness, cough, vomiting, weakness, and swelling of feet and ankles. This is not a complete list of side effects. Tell your doctor about any side effect that bothers you or does not go away.

You are encouraged to report side effects of NUEDEXTA^® (dextromethorphan HBr and quinidine sulfate). Please contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 (www.fda.gov/medwatch).

Please read accompanying FULL PRESCRIBING INFORMATION and IMPORTANT SAFETY INFORMATION, also available at treatingPBA.com.

References

1. Ahmed A, Simmons Z. Pseudobulbar affect: Prevalence and management: TCRM. Therapeutics and Clinical Risk Management. November 29, 2013. Accessed December 13, 2023. https://doi.org/10.2147/TCRM.S53906.
2. Understanding multiple sclerosis. National Multiple Sclerosis Society. Accessed December 13, 2023. https://www.nationalmssociety.org/What-is-MS/MS-FAQ-s.
3. Vidović V, Rovazdi MC, Kraml O, Kes VB. PSEUDOBULBAR AFFECT IN MULTIPLE SCLEROSIS PATIENTS. Acta Clinica Croatica. 2015;54(2):159-163. Accessed January 31, 2024. https://pubmed.ncbi.nlm.nih.gov/26415311/
4. Pseudobulbar affect (PBA). Brain Injury Association of America. November 7, 2023. Accessed December 13, 2023. https://www.biausa.org/brain-injury/about-brain-injury/pba.