Hello, hello! Hope everyone who is living in cold climates is staying warm and safe. On today’s “Doctor’s Call” segment on Boston Herald Radio, hosts Jaclyn Cashman and Hillary Chabot asked me about a rare neurologic condition called Pseudobulbar Affect (PBA), as well as back pain (especially in light of shoveling during nonstop snowfall) and the common cold. Listen here:
Pseudobulbar Affect (PBA)
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Signs/Symptoms:
- sudden onset of involuntary laughing or crying; unpredictable; some patients describe it as coming on like a seizure
- lasts a few seconds to several minutes
- can occur several times per day
Cause: not exactly known. Thought to be a disconnect between the brainstem (where emotions originate) and the frontal lobe (which determines how emotions are expressed)
Social Impact: PBA can have a significant, adverse effect on a person’s life. They often avoid social and professional events out of embarrassment and shame. This can also have a negative effect on their overall health as they may not seek medical attention when necessary.
Different from Depression:
1. In PBA, the physical expression contrasts with the emotion. That is, the person may feel sad but instead laughs. In depression, a person’s outward expression is consistent with his or her inner mood.
2. In PBA, the episodes of laughter or crying are typically brief and sudden; depression, however, tends to be longer-lasting
Treatment: Accurate and timely diagnosis by a health care professional is key. Once identified, treatment can include:
1. Antidepressants – e.g. fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), nortriptyline (Pamelor), others
2. Dextromethorphan/Quinidine (“Nuedexta”) — this is the 1st FDA-approved drug for treating PBA; shown to decrease laughing and crying episodes in patients with ALS and MS vs placebo
PBA Info.org (image) http://www.pbainfo.org/hcp
Background:
- Acute low back pain is one of the most common reasons why patients see their doctor
- Most patients recover relatively quickly, within days to weeks, with conservative management
Image may be NSFW.
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- Important for patients and health professionals to look out for ‘red flags’ or warning signs:
–> motor or sensory deficits
–> new-onset bladder or bowel incontinence
–> history of cancer metastasis to the bone
–> suspected spinal infection
–> history of severe trauma related to age (e.g. motor vehicle accident in a young patient; minor fall in an elderly patient with osteoporosis)
Treatment: Vast majority of cases are benign musculoskeletal cases and self-limiting.
-NSAIDs (e.g. ibuprofen, naproxyn) are first-line treatment
-Acetaminophen (i.e. Tylenol) and muscle relaxants (e.g. Flexeril, Zanaflex) can also reduce pain.
-Physical Therapy can minimize symptoms by strengthening surrounding muscles, tendons, ligaments
-Rare, serious causes of back pain (fracture, cancer, infection, etc.) will require additional evaluation and possible hospitalization
REFERENCES:
Massachusetts General Hospital http://www.massgeneral.org/conditions/condition.aspx?id=275
Mayo Clinic http://www.mayoclinic.org/diseases-conditions/back-pain/basics/definition/con-20020797
National Institute of Neurologic Disorders & Stroke http://www.ninds.nih.gov/disorders/backpain/backpain.htm
Spine Health http://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-diagnosis-and-treatment
PixShark (image) http://pixshark.com/back-pain-cartoon.htm
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