A to Z of MS
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A to Z of MS Emotionalism
Some people with multiple sclerosis may find that they laugh or cry with minimal provocation or at inappropriate times. This is because MS lesions have occurred in the areas of the brain that govern the emotional pathways. These symptoms are also called pseudobulbar affect.
Pathological laughing and crying is a physical disorder that results from disturbance of emotional expression rather than a disturbance of feelings. Whilst an individual may laugh or cry uncontrollably, this doesn't indicate that they feel happy or sad.
Emotional lability is characterised by an excessive emotional response to a minor stimulus.
Both symptoms are different from mood swings, which may also be experienced in MS.
Both pathological laughing and crying and emotional lability are transient, short lived changes which usually resolve quickly.
The NICE Guidelines state that the individual should be offered full assessment of their emotional state by someone with suitable expertise. If the emotionalism is sufficient to cause concern or distress people should be offered treatment with antidepressant therapy or behavioural management strategies.
In 2010 Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) was licensed in the USA as a treatment for uncontrolled laughing or crying. The drug is not yet licensed in the UK.
References
Work SS, et al.
Pseudobulbar affect: an under-recognized and under-treated neurological disorder.
Annals of Neurology 2006;59(5):780-787.
abstract
Panitch HS, et al.
Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis.
Advances in Therapy 2011; 28(7):586-601.
abstract