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Inappropriate Laughing or Crying: A Lesser-Known Side Effect of Stroke
Dr. Benjamin Nager explains what the pseudobulbar affect is, how common it is, how it affects a patient and their family, and treatment options available.
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Learn more about Benjamin Nager, MD
Benjamin Nager, MD
Benjamin Nager, MD is a Neurologist with Northwestern Medicine.Learn more about Benjamin Nager, MD
Transcription:
Melanie Cole, MS (Host): Inappropriate laughing or crying can be a lesser known side effect of stroke. My guest today is Dr. Benjamin Nager. He’s a neurologist with North Western Medicine. Dr. Nager, I’m so glad to have you with us today. Tell us a little bit about this inappropriate laughing or crying; the pseudobulbar affect.
Benjamin Nager, MD (Guest): Well thanks for asking. Pseudobulbar affect is a strange and unusual condition that occurs in a lot of different patients with different neurological conditions, but specifically we were going to speak about stroke patients today, and it is something that really hasn’t been well recognized in the public. We see it in about 20% of our stroke patients. It does occur a little bit more commonly acutely following a stroke and then gradually starts to decrease in frequency. But it causes an uncomfortable situation in the home where the person who suffered the stroke will sometimes have inappropriate emotional responses to things. So, they may giggle or laugh inappropriately and more commonly, and I think it’s more bothersome to the family is when the person cries.
Host: Dr. Nager, can this condition, PBA, occur with other neurological conditions? Is it just associated with stroke or are there other reasons it can have that effect?
Dr. Nager: Well, I’m glad you asked. It can occur with other conditions. The things that I see most commonly are multiple sclerosis and there are other conditions like Lou Gehrig's disease or amyotrophic lateral sclerosis. Conditions that cause damage in both sides of the brain. So, say traumatic brain injury can also result in this.
Host: So, are there certain situations that might trigger the crying or laughing, or do they just happen on their own and for no reason?
Dr. Nager: Well, both can occur, but I think generally a minor emotional stimulus. So, say watching a tv commercial that might be a little bit sad about dogs that aren’t being treated appropriately, might trigger hysterical crying, and something that might have a little bit of humor in it could trigger a lot of laughter. If it happens in public, it’s quite embarrassing.
Host: So, tell us about the percentage of patients that suffer from PBA after a stroke? Is this a large population and you said that it can happen acutely? Does it then in a larger population tend to decrease or even go away?
Dr. Nager: Absolutely, the statistics seem to show that about 30% or so of patients will get it after a stroke and if you look at people down the road, say six months to a year, that number drops to about 20%.
Host: Wow, so you mentioned the family, how it affects the patient and the family. Does the patient realize that they're laughing or crying inappropriately, Dr. Nager? As you said it can be a little bit embarrassing. What would you like family members to know if this happens in public?
Dr. Nager: Well, the first thing is that it isn’t something that’s under the person’s control. I think the crying is upsetting and the laughter is also very upsetting, and it could be embarrassing when it happens out in public, and it might be inappropriate because it makes the person the center of attention. That’s the last thing that they want and no, they really don’t have any control over this and sometimes the harder they try to suppress it the worse it gets. I think you can think of people in your life who always were known as criers or people who seem to snicker and laugh inappropriately, and it really isn’t something that they can control. It’s just part of how they function at that particular time.
Host: So, what can be done about it? What treatments might be available? Is there medicational intervention or are there positional changes; things that they can do?
Dr. Nager: Absolutely, a few years ago a drug was released that’s called Nuedexta, which is a combination of two medications. One of which the main ingredient is actually a commonly used cough suppressant called dextromethorphan. That seems to work quite well in decreasing the severity of these episodes. We also use anti-depressants. Psychologists will give patients exercises that they can do to try to distract them and make it less likely that they’ll have an emotional response to certain stimuli, but the medications themselves would be the most effective.
Host: Now is this something that since it can decrease after the stroke, that then the medication changes or maybe they don’t have to be on it at all?
Dr. Nager: Yes, so about a third of the patients who get it will ultimately evolve out of it as their condition, you know, improves over time.
Host: Wow, it’s so interesting, Dr. Nager. So, what would you like the family and friends to know about supporting somebody with PBA at that time and any questions that you really want them to ask the doctor because, you know, we go with our loved ones when they go to their neurologist for their post stroke appointments? What would you like us to ask about this?
Dr. Nager: Well, I think the first thing is to make sure that the health professional that the person sees is aware of the concerns off the family. Particularly, if they notice a change in behavior or response and it’s not a sign that there is an impending terrible thing that’s going to happen to the person. It is something that can improve with time and can certainly improve with treatment. So, we need to remember first that its not the persons fault and they're not guilty of anything if they embarrass themselves. And second, it is a treatable condition that may go away on its own but certainly will respond to therapy. So, please ask or mention the problem.
Host: That’s so important to know. Do you have any final thoughts Dr. Nager? As, you know, even if someone starts to notice this day after stroke or six months later. What would you like them to know about PBA in general? Do you have any final thoughts for us?
Dr. Nager: Just that, I think people want to get better. And if the person is bothered by this thing that occurs, that’s come on because of their condition, don’t be afraid to mention it to their healthcare professional.
Host: I think that’s the main message, is that while it can be uncomfortable for patients, for their families, it’s not their fault. Talk to your healthcare professional about it because there are treatment options available and that wraps up this episode of North Western Medicine Pod Talk. For more information on the latest advances in medicine, head on over to our website at nm.org for more information and to get connected with one of our providers. If you found this podcast as interesting as I did, please share on your social media, share with your friends and family, and be sure to check out all the other informative podcasts in our library. I’m Melanie Cole.
Melanie Cole, MS (Host): Inappropriate laughing or crying can be a lesser known side effect of stroke. My guest today is Dr. Benjamin Nager. He’s a neurologist with North Western Medicine. Dr. Nager, I’m so glad to have you with us today. Tell us a little bit about this inappropriate laughing or crying; the pseudobulbar affect.
Benjamin Nager, MD (Guest): Well thanks for asking. Pseudobulbar affect is a strange and unusual condition that occurs in a lot of different patients with different neurological conditions, but specifically we were going to speak about stroke patients today, and it is something that really hasn’t been well recognized in the public. We see it in about 20% of our stroke patients. It does occur a little bit more commonly acutely following a stroke and then gradually starts to decrease in frequency. But it causes an uncomfortable situation in the home where the person who suffered the stroke will sometimes have inappropriate emotional responses to things. So, they may giggle or laugh inappropriately and more commonly, and I think it’s more bothersome to the family is when the person cries.
Host: Dr. Nager, can this condition, PBA, occur with other neurological conditions? Is it just associated with stroke or are there other reasons it can have that effect?
Dr. Nager: Well, I’m glad you asked. It can occur with other conditions. The things that I see most commonly are multiple sclerosis and there are other conditions like Lou Gehrig's disease or amyotrophic lateral sclerosis. Conditions that cause damage in both sides of the brain. So, say traumatic brain injury can also result in this.
Host: So, are there certain situations that might trigger the crying or laughing, or do they just happen on their own and for no reason?
Dr. Nager: Well, both can occur, but I think generally a minor emotional stimulus. So, say watching a tv commercial that might be a little bit sad about dogs that aren’t being treated appropriately, might trigger hysterical crying, and something that might have a little bit of humor in it could trigger a lot of laughter. If it happens in public, it’s quite embarrassing.
Host: So, tell us about the percentage of patients that suffer from PBA after a stroke? Is this a large population and you said that it can happen acutely? Does it then in a larger population tend to decrease or even go away?
Dr. Nager: Absolutely, the statistics seem to show that about 30% or so of patients will get it after a stroke and if you look at people down the road, say six months to a year, that number drops to about 20%.
Host: Wow, so you mentioned the family, how it affects the patient and the family. Does the patient realize that they're laughing or crying inappropriately, Dr. Nager? As you said it can be a little bit embarrassing. What would you like family members to know if this happens in public?
Dr. Nager: Well, the first thing is that it isn’t something that’s under the person’s control. I think the crying is upsetting and the laughter is also very upsetting, and it could be embarrassing when it happens out in public, and it might be inappropriate because it makes the person the center of attention. That’s the last thing that they want and no, they really don’t have any control over this and sometimes the harder they try to suppress it the worse it gets. I think you can think of people in your life who always were known as criers or people who seem to snicker and laugh inappropriately, and it really isn’t something that they can control. It’s just part of how they function at that particular time.
Host: So, what can be done about it? What treatments might be available? Is there medicational intervention or are there positional changes; things that they can do?
Dr. Nager: Absolutely, a few years ago a drug was released that’s called Nuedexta, which is a combination of two medications. One of which the main ingredient is actually a commonly used cough suppressant called dextromethorphan. That seems to work quite well in decreasing the severity of these episodes. We also use anti-depressants. Psychologists will give patients exercises that they can do to try to distract them and make it less likely that they’ll have an emotional response to certain stimuli, but the medications themselves would be the most effective.
Host: Now is this something that since it can decrease after the stroke, that then the medication changes or maybe they don’t have to be on it at all?
Dr. Nager: Yes, so about a third of the patients who get it will ultimately evolve out of it as their condition, you know, improves over time.
Host: Wow, it’s so interesting, Dr. Nager. So, what would you like the family and friends to know about supporting somebody with PBA at that time and any questions that you really want them to ask the doctor because, you know, we go with our loved ones when they go to their neurologist for their post stroke appointments? What would you like us to ask about this?
Dr. Nager: Well, I think the first thing is to make sure that the health professional that the person sees is aware of the concerns off the family. Particularly, if they notice a change in behavior or response and it’s not a sign that there is an impending terrible thing that’s going to happen to the person. It is something that can improve with time and can certainly improve with treatment. So, we need to remember first that its not the persons fault and they're not guilty of anything if they embarrass themselves. And second, it is a treatable condition that may go away on its own but certainly will respond to therapy. So, please ask or mention the problem.
Host: That’s so important to know. Do you have any final thoughts Dr. Nager? As, you know, even if someone starts to notice this day after stroke or six months later. What would you like them to know about PBA in general? Do you have any final thoughts for us?
Dr. Nager: Just that, I think people want to get better. And if the person is bothered by this thing that occurs, that’s come on because of their condition, don’t be afraid to mention it to their healthcare professional.
Host: I think that’s the main message, is that while it can be uncomfortable for patients, for their families, it’s not their fault. Talk to your healthcare professional about it because there are treatment options available and that wraps up this episode of North Western Medicine Pod Talk. For more information on the latest advances in medicine, head on over to our website at nm.org for more information and to get connected with one of our providers. If you found this podcast as interesting as I did, please share on your social media, share with your friends and family, and be sure to check out all the other informative podcasts in our library. I’m Melanie Cole.