Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis.
OBJECTIVE
To evaluate the efficacy and safety of DM/Q (capsules containing dextromethorphan [DM] and quinidine [Q]) compared with placebo, taken twice daily, for the treatment of pseudobulbar affect over a 12-week period in multiple sclerosis patients.


METHODS
A total of 150 patients were randomized in a double-blind, placebo-controlled study to assess pseudobulbar affect with the validated Center for Neurologic Study-Lability Scale. Each patient also recorded the number of episodes experienced between visits, estimated quality of life and quality of relationships on visual analog scales, and completed a pain rating scale.


RESULTS
Patients receiving DM/Q had greater reductions in Center for Neurologic Study-Lability Scale scores than those receiving placebo (p < 0.0001) at all clinic visits (days 15, 29, 57, and 85). All secondary end points also favored DM/Q, including the number of crying or laughing episodes (p <or= 0.0077), quality of life (p < 0.0001), quality of relationships (p = 0.0001), and pain intensity score (p = 0.0271). DM/Q was well tolerated; only dizziness occurred with greater frequency than with placebo.


CONCLUSIONS
Results in multiple sclerosis patients were similar to those of a previous study in amyotrophic lateral sclerosis, demonstrating that DM/Q may be beneficial in treating potentially disabling pseudobulbar affect in a variety of neurological disorders.
Panitch
Hillel S
HS
Neurology Health Care Service, Fletcher Allen Health Care, University of Vermont, Burlington, 05401, USA. hillel.panitch@vtmednet.org
Thisted
Ronald A
RA
Smith
Richard A
RA
Wynn
Daniel R
DR
Wymer
James P
JP
Achiron
Anat
A
Vollmer
Timothy L
TL
Mandler
Raul N
RN
Dietrich
Dennis W
DW
Fletcher
Malcolm
M
Pope
Laura E
LE
Berg
James E
JE
Miller
Ariel
A
D000339:Affect / Q000187:drug effects*; D000368:Aged; D003448:Crying; D003915:Dextromethorphan / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D018691:Excitatory Amino Acid Antagonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007845:Laughter; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000523:psychology*; D010147:Pain Measurement / Q000187:drug effects; D011788:Quality of Life; D011802:Quinidine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*
D004338:Drug Combinations; D018691:Excitatory Amino Acid Antagonists; D003915:Dextromethorphan; D011802:Quinidine