PBA and MS

PBA and MS

Pseudobulbar Affect and Multiple Sclerosis

Multiple sclerosis (MS) is associated with a range of symptoms. From poor memory, weakness and numbness, to vision and balance problems, MS affects different people in different ways. Many people with MS experience mood related symptoms like depression, irritability, agitation and anger. Given the powerful impact of MS, these symptoms are typical and are often diagnosed as a depressive disorder.

However, some recent research indicates that there may be another explanation for these symptoms. Studies show that mood symptoms resulting from MS may actually be pseudobulbar affect (PBA). PBA is an involuntary emotional expression disorder marked by quickly changing emotions and emotional incongruence. A person will PBA may have uncontrollable fits of hysterical laughter when nothing is funny, or be unable to stop crying even though nothing is sad.

PBA affects people with ALS, traumatic brain injury, stroke, MS and dementia, among other conditions. It usually occurs when there is some level of damage to the brain, like the nerve damage caused by MS. It is thought that PBA and MS occur together reasonably frequently.

Bowl Over PBA

Whether it is MS, PBA or both creating your symptoms, there is a path to follow for appropriate diagnosis and treatment.  Here’s how to start on that path:

  • Educate yourself. PBA is not a condition that many people are familiar with, but the research is growing. Estimates claim that between 10% and 80% of people with MS also have PBA so uncertainty continues. One major difference between PBA and depression is that people with PBA do not usually experience hopelessness or changes in sleep or appetite. Seek information from trusted sources and ask questions to gather facts.
  • Track your symptoms. Monitoring yourself and your responses to situations can provide valuable data. Consider creating a spreadsheet to calculate how many times a day you laugh or cry. Include the triggers that provoked your reaction and decide if the number seems excessive or the triggers seem odd. Your family, friends and coworkers are a fantastic source of information. Ask their opinion and understand their perception.
  • Seek medical opinion.  Now that you’ve armed yourself with education and the data you’ve collected, consult with your doctor. Neurologists and psychiatrists tend to diagnosis and treat PBA more often than other physicians. Consider a referral if needed.
  • Find treatment. The diagnosing doctor will discuss treatment options, which are somewhat limited. A medication has been approved to treat PBA that can limit symptoms. Also, trying behavioral interventions like deep breathing exercises and progressive muscle relaxation can provide some level of damage control once symptoms appear. Working to avoid potential triggers can offer some prevention.
  • Work towards acceptance. A PBA diagnosis can change the way other people see you and the way you see yourself. Communicating openly and honestly with people in your life is a good step toward finding acceptance. Let them know what to expect and what they can do to improve the situation. Working to have accurate expectations will be very important. Since PBA is involuntary, you will not be able to control symptoms. Acceptance and communication will decrease embarrassment.


MS comes with a host of symptoms and side effects. Accurately diagnosing and treating symptoms can drastically improve your quality of life. If you think PBA could be affecting your life, follow these tips and hopefully you will find relief.



MSF (Reining in Pseudobulbar Affect)

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