title: Pseudobulbar affect: an under-recognized and under-treated neurological disorder.
abstract: BACKGROUND
  Pseudobulbar affect (PBA) is a neurologic syndrome of emotional affect disinhibition, characterized by uncontrollable, exaggerated, and often inappropriate emotional outbursts, which may cause severe distress, embarrassment, and social dysfunction. However, the US prevalence of PBA remains unknown.
  
  
  METHODS
  An online survey was conducted primarily to estimate the US prevalence of PBA in patients with the six most commonly associated conditions: Alzheimer's disease, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, stroke, and traumatic brain injury. Invitations to participate were randomly sent online to adults (aged ≥ 18 years) registered in the Harris Poll Online Panel who were patients or belonged to a household with a patient diagnosed with one of the six conditions (identified through previous screening by Harris Interactive). Participants were screened for PBA using the Pathological Laughing and Crying Scale (PLACS) and the Center for Neurologic Study-Lability Scale (CNS-LS). PBA estimates were made using a cut-off score of ≥ 13 on the PLACS and two different cut-off thresholds on the CNS-LS, a lower one of ≥ 13 and a more rigorous one of ≥ 21. Existing US prevalence data for the six underlying conditions were used to estimate US prevalence of PBA.
  
  
  RESULTS
  Of 38,000 individuals invited to participate, 8876 responded (23%) and 2318 (26%) completed the questionnaire. Mean prevalence of PBA across all six conditions was 10.1%, 9.4%, and 37.5% with the PLACS ≥ 13, CNS-LS ≥ 21, and CNS-LS ≥ 13 thresholds, respectively. Using disease population estimates from government agencies and professional organizations, the estimated US population with PBA ranged from 1.8 to 7.1 million. Among patients who discussed their laughing and/or crying episodes with a physician, 41% were diagnosed, and about half received a medication for their episodes.
  
  
  CONCLUSIONS
  The overall prevalence of PBA was estimated to be about 10% across these commonly associated underlying neurological conditions and appears to be under-recognized.
authors.affiliation: Avanir Pharmaceuticals, Inc., 101 Enterprise, Suite 300, Aliso Viejo, CA, 92656, USA. SWork@avanir.com
authors.forename: Susan S
authors.initials: SS
authors.lastname: Work
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Colamonico
authors.forename: Walter G
authors.initials: WG
authors.lastname: Bradley
authors.forename: Randall E
authors.initials: RE
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000544:Alzheimer Disease / Q000453:epidemiology; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology; D009422:Nervous System Diseases / Q000453:epidemiology; D010300:Parkinson Disease / Q000453:epidemiology; D020828:Pseudobulbar Palsy / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult