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Treating Involuntary Crying and Laughing

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The Connection Between Pseudobulbar Affect (PBA) and Parkinson’s Disease

Medically Reviewed By Nancy Hammond, M.D.

Pseudobulbar Affect (PBA) can cause involuntary episodes of laughing or crying. The episodes are common complications of Parkinson’s disease and other neurological disorders.

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Some more widely recognized symptoms of Parkinson’s disease include muscle stiffness, tremors of the limbs and head, and difficulty with coordination and balance. A lesser-known but common symptom is pseudobulbar affect (PBA).

PBA is characterized by brief involuntary episodes of laughing or crying. The episodes may last a few seconds or minutes, and their arrival is usually unpredictable.

Despite being characterized by laughter, tears, or both, PBA is not an emotional or psychological condition. It’s a neurological disorder that occurs when regions of the brain involved with emotional regulation, such as the cerebellum and cerebral cortex, become impaired.

The changes in brain chemistry that contribute to Parkinson’s disease, such as a reduction in dopamine levels, also may contribute to PBA.

In addition to Parkinson’s disease, other conditions are often accompanied by PBA, including:

  • Alzheimer’s disease
  • multiple sclerosis
  • stroke
  • traumatic brain injury (TBI)
  • amyotrophic lateral sclerosis (ALS)

PBA and Parkinson’s disease

A 2021 study suggests that about 41% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of people with Parkinson’s disease in the study may have PBA. The actual percentage of individuals with Parkinson’s disease and PBA may be higher, as bouts of involuntary crying or laughing are often misdiagnosed as signs of depression — another common complication of Parkinson’s disease.

Research from 2019 Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source also suggests that the challenges of having both Parkinson’s disease and PBA are associated with a greater risk of depression and a lower quality of life.

For these reasons, it’s essential to recognize episodes of involuntary emotional reactions as possible signs of PBA and seek a diagnosis. If your primary care doctor is unfamiliar with PBA, talk with a neurologist or psychiatrist about your symptoms.

In addition to being able to describe your laughing or crying episodes, including their duration and frequency, try to take note of when they occur. You may have noticed that there are specific triggers that lead to repeated PBA episodes. Recognizing them and avoiding or reducing your exposure to them may be helpful.

Treating PBA

Doctors have treated PBA with antidepressants for many years, often with mixed results. However, the Food and Drug Administration (FDA) approved a new medication in 2020 exclusively for treating PBA.

The combination drug dextromethorphan HBr and quinidine sulfate (Nuedexta) is part of a class of drugs called N-methyl-D-aspartate (NMDA) receptor antagonists. NMDA receptor antagonists are usually prescribed to help slow the progression of Alzheimer’s disease.

Some people with PBA find relief with non-medication strategies, such as distraction and relaxation. When you sense that a PBA episode is developing, you may be able to head it off or shorten its duration by thinking about subjects completely unrelated to your current situation.

You may also find some relief by taking a few deep breaths and relaxing your muscles. Changing your posture or body position may also work. Though these strategies can be more challenging with Parkinson’s disease, you may be able to improve with practice or by working with a physical therapist.

Takeaway

Parkinson’s disease can cause a range of physical and emotional challenges, and PBA is just one more hurdle to maintaining your quality of life.

However, with medication and self-care strategies, PBA can often be managed. Learning as much as possible about PBA and sharing the information with others can be beneficial.

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    1. Depression in Parkinson's. (n.d.) https://www.apdaparkinson.org/what-is-parkinsons/symptoms/depression/
    2. Falconer, R., et al. (2021). Prevalence of pseudobulbar affect (PBA) in Parkinson’s disease: An underrecognized patient burden. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629689/
    3. Hakimi, M., et al. (2019). Pseudobulbar affect in Parkinsonian disorders: A review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369372/


Medical Reviewer: Nancy Hammond, M.D.
Last Review Date: 2023 May 3
View All Treating Involuntary Crying and Laughing Articles
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