Pseudobulbar palsy

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"Pseudobulbar" redirects here. For the emotional condition, see Pseudobulbar affect.
Pseudobulbar palsy
SpecialtyNeurology

Pseudobulbar palsy is a medical condition characterized by the inability to control facial movements (such as chewing and speaking) and caused by a variety of neurological disorders. Patients experience difficulty chewing and swallowing, have increased

bulbar region, and demonstrate slurred speech (which is often the initial presentation of the disorder), sometimes also demonstrating uncontrolled emotional outbursts.[1]

The condition is usually caused by the bilateral damage to

brain stem
.

Signs and symptoms

Signs and symptoms of pseudobulbar palsy include:

Causes

Pseudobulbar palsy is the result of damage of

motor fibers traveling from the cerebral cortex to the lower brain stem. This damage might arise in the course of a variety of neurological conditions that involve demyelination and bilateral corticobulbar lesions. Examples include:[3]

Pathophysiology

The proposed mechanism of pseudobulbar palsy points to the disinhibition of the motor neurons controlling laughter and crying, proposing that a reciprocal pathway exists between the cerebellum and the brain stem that adjusts laughter and crying responses, making them appropriate to context.[5] The pseudobulbar crying could also be induced by stimulation in the region of the subthalamic nucleus of the brain.[6]

Diagnosis

Diagnosis of pseudobulbar palsy is based on observation of the symptoms of the condition. Tests examining

gag reflex can also be performed. It has been suggested that the majority of patients with pathological laughter and crying have pseudobulbar palsy due to bilateral corticobulbar lesions and often a bipyramidal involvement of arms and legs.[7] To further confirm the condition, MRI can be performed to define the areas of brain abnormality.[citation needed
]

Treatment

Since pseudobulbar palsy is a syndrome associated with other diseases, treating the underlying disease may eventually reduce the symptoms of pseudobulbar palsy.[citation needed]

Possible pharmacological interventions for pseudobulbar affect include the

quinidine sulfate. Nuedexta is an FDA approved medication for pseudobulbar affect. Dextromethorphan, an N-methyl-D-aspartate receptor antagonist, inhibits glutamatergic transmission in the regions of the brainstem and cerebellum, which are hypothesized to be involved in pseudobulbar symptoms, and acts as a sigma ligand, binding to the sigma-1 receptors that mediate the emotional motor expression.[5]

See also

References

  1. ^ Tidy C (21 October 2021). Knott L (ed.). "Bulbar and Pseudobulbar Palsy. What is Bulbar Palsy?". Patient. Retrieved 2016-03-26.
  2. PMID 17167648
    .
  3. ^ Saleem, Fatima; Munakomi, Sunil (2024). "Pseudobulbar Palsy". StatPearls. StatPearls Publishing. Retrieved 20 February 2024.
  4. PMID 7484639
    .]
  5. ^
    PMID 18305298
    .
  6. PMID 15146017
    .
  7. PMID 2738597
    .

External links
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