title: Neuroanatomy of pseudobulbar affect : a quantitative MRI study in multiple sclerosis.
abstract: Pseudobulbar affect (PBA) is defined as episodes of involuntary crying, laughing, or both in the absence of a matching subjective mood state. This neuropsychiatric syndrome can be found in a number of neurological disorders including multiple sclerosis (MS). The aim of this study was to identify neuroanatomical correlates of PBA in multiple sclerosis (MS) using a case-control 1.5T MRI study. MS patients with (n = 14) and without (n = 14) PBA were matched on demographic, disease course, and disability variables. Comorbid psychiatric disorders including depressive and anxiety disorders were absent. Hypo- and hyperintense lesion volumes plus measurements of atrophy were obtained and localized anatomically according to parcellated brain regions. Between-group statistical comparisons were undertaken with alpha set at 0.01 for the primary analysis. Discrete differences in lesion volume were noted in six regions: Brainstem hypointense lesions, bilateral inferior parietal and medial inferior frontal hyperintense lesions, and right medial superior frontal hyperintense lesions were all significantly higher in the PBA group. A logistic regression model identified four of these variables (brainstem hypointense, left inferior parietal hyperintense, and left and right medial inferior frontal hyperintense lesion volumes) that accounted for 70% of the variance when it came to explaining the presence of PBA. In conclusion, MS patients with PBA have a distinct distribution of brain lesions when compared to a matched MS sample without PBA. The lesion data support a widely-dispersed neural network involving frontal, parietal, and brainstem regions in the pathophysiology of PBA.
authors.affiliation: Neuropsychiatry Division, Dept. of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, FG08-2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
authors.forename: Omar
authors.initials: O
authors.lastname: Ghaffar
authors.forename: Laury
authors.initials: L
authors.lastname: Chamelian
authors.forename: Anthony
authors.initials: A
authors.lastname: Feinstein
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000209:etiology / Q000523:psychology*; D001284:Atrophy; D001921:Brain / Q000473:pathology; D016022:Case-Control Studies; D019260:Expressed Emotion; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology* / Q000523:psychology; D011379:Prognosis