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Uncontrollable Crying and/or Laughing: Get to Know PseudoBulbar Affect (PBA)

Posted by Avanir Pharmaceuticals Jul 06 2017

After suffering a stroke, Dyanna Hurley began to experience episodes of sudden, frequent and uncontrollable crying and laughing that did not match how she was feeling. Dyanna had already stopped working as a traditional nurse due to struggles with the right side of her body following the stroke, and because of the crying and laughing episodes, she noticed changes in aspects of her personal life as well. Weekly dinners with her friends became less enjoyable because she felt like everyone was looking at her when she was having a PBA episode, and it made her feel uncomfortable and embarrassed. 

Dyanna (left) and her sister, Kathie

Though she did not know what was wrong, she knew something was going on and that she was not getting the answers she needed. About a year after her stroke, Dyanna asked her primary care physician to send her to a neurologist, who diagnosed Dyanna with PseudoBulbar Affect (PBA), which can occur secondary to neurologic conditions such as stroke.

What Is PBA?

PBA is a distinct condition that can happen to people after they suffer from a traumatic brain injury or neurologic condition such as stroke. It results in sudden, frequent and uncontrollable episodes of crying and/or laughing that don’t match how a person feels.1 It affects about two million people in the U.S.2

Who is diagnosed with PBA?

Conditions or injuries that can lead to PBA include stroke; traumatic brain injury (TBI); Alzheimer’s disease (AD) and dementia; multiple sclerosis (MS); Parkinson’s; or amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease. These conditions or brain injury can affect the signals that tell a person’s body when or how much to cry or laugh. This can trigger episodes of crying and/or laughing that are sudden and exaggerated (more intense or lasting longer than expected) or mismatched (not fitting the situation). 1

Because people who have had a stroke or who are living with Alzheimer’s disease and dementia, TBI, MS, Parkinson’s or ALS are focused on managing these conditions, symptoms of PBA are often overlooked or mischaracterized as depression. Additionally, the way people with PBA describe episodes may sound similar to symptoms of depression. However, PBA and depression are two separate conditions. While these conditions can often coexist—meaning some people can have both PBA and depression—both conditions are manageable and should be independently diagnosed. 1

When she was diagnosed, Dyanna felt relieved to finally have a name for the symptoms she was experiencing. Before receiving the PBA diagnosis, Dyanna’s family thought these episodes were her way of seeking attention, and it was hard for Dyanna having her family not believe that she felt something was medically wrong. After receiving the diagnosis, Dyanna felt validated that something was in fact medically wrong all along and that there was a way to manage it.

Talk to your doctor

It is important for people who have had a stroke or who are living with Alzheimer’s disease and dementia, TBI, MS, Parkinson’s or ALS, or their loved ones, talk to the doctor if these symptoms are present, as it could be PBA, and ask if it can be managed. It is important to share with your doctor if episodes are impacting your life. To prepare for a discussion with your doctor, you can take a short quiz at Your answers may help start a conversation with your doctor.

1. Miller A, Pratt H, Schiffer RB. Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments. Expert Rev. Neurother. 11(7), 1077–1088 (2011).
2.  Brooks BR, et al. PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions. PLoS ONE. 2013; 8(8): e72232. doi:10.1371/journal.pone.0072232

The National Stroke Association provides educational information about treatments for post-stroke issues through real-life stories. Promotion of these stories does not imply endorsement of any product or service and it is recommended that patients ask a healthcare professional before using any product, medicine, or therapy.

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