What is PBA?

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PBA (Pseudobulbar Affect) is a medical condition causing sudden, frequent, uncontrollable crying and/or laughing that doesn’t match how you feel. It can happen in people living with a brain injury or certain neurologic conditions including:

  •  TBI (Traumatic Brain Injury)
  •  Alzheimer’s Disease/Dementia
  •  Stroke
  •  MS (Multiple Sclerosis)
  •  ALS (Lou Gehrig’s Disease)
  •  Parkinson’s Disease

Why treat PBA?

We express our emotions to connect with those around us and having PBA may affect that connection. Because PBA episodes are unpredictable and can happen at inappropriate times, including social situations, they can leave you feeling misunderstood and frustrated.

Reducing the number of PBA episodes you experience could help ensure that your crying and/or laughing more often matches how you feel. NUEDEXTA is the only treatment approved by the FDA to treat PBA.

 

Recognizing PBA

After experiencing certain neurologic conditions or a brain injury, watch for sudden, frequent, uncontrollable episodes of crying and/or laughing that are:

Unpredictable icon
Unpredictable

PBA episodes can happen at any time. These crying and/or laughing episodes might or might not seem to be triggered by what’s happening at the moment.

Exaggerated icon
Exaggerated

Crying and/or laughing during a PBA episode may be more intense or last longer than expected. For example, a person may cry excessively or for a long time after seeing a touching movie or laugh at a joke long after others have stopped.

Mismatched icon
Mismatched

PBA episodes might appear inappropriate: They might not fit the situation or how the person is feeling. For example, a person might laugh at a funeral or cry when a friend shares good news.

There are times when I feel fine one minute, and then I'll become tearful the next over something small or for no reason at all. There are times when the person seems to feel fine one minute, and then becomes tearful the next over something small or for no reason at all.

 

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out of a possible 35 on the PBA quiz.

35

In studies, scores of 13 or higher were more likely to suggest PBA.

Sharing these results with a doctor is a good first step towards discussing PBA and seeking treatment with NUEDEXTA.

This score does not diagnose PBA, and lower or higher scores can occur in persons with and without PBA. Only your doctor can determine if you have PBA.

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The Center for Neurologic Study-Lability Scale (CNS-LS) was developed by healthcare professionals to identify and measure symptoms suggestive of PBA. It does not diagnose PBA and is not intended to substitute for professional medical assessment and/or advice. Please consult with your doctor.

Conditions that can cause PBA

PBA can affect both men and women. PBA is thought to affect about 2 million people in the US who suffer from certain neurologic conditions or brain injury.†


Stroke
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Stroke

Because people recovering from a stroke are often concerned with regaining lost function—and preventing another stroke—it may be easy to overlook sudden, frequent, uncontrollable crying and/or laughing symptoms that don’t match how they feel or mistake the symptoms for depression.

For about a quarter of a million people in the US who have suffered a stroke, these laughing and crying episodes may be PBA.

According to a survey of 500 patients who suffered a stroke (or their caregivers), 4.3% may have PBA. Based on this data, nearly 250,000 patients who suffered a stroke in the United States may have PBA.†

Traumatic Brain Injury (TBI)
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Traumatic Brain Injury (TBI)

Some patients living with TBI experience PBA symptoms of frequent, uncontrollable crying and/or laughing very soon after their injury. While for others, these symptoms may not be recognized until some months after their TBI, during the recovery process. Some never experience PBA symptoms at all.

According to studies, 800,000 people in the US, or about 15% of those who have suffered a Traumatic Brain Injury, may have PBA.

According to a survey of 326 patients with TBI (or their caregivers), 15% may have PBA. Based on this data, 800,000 patients with TBI in the United States may have PBA.†

Alzheimer's Disease and Dementia
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Alzheimer's Disease and Dementia

Alzheimer’s disease and other dementias can make PBA especially hard to spot, since sudden episodes of crying and/or laughing can be mistaken for depression or other personality changes associated with dementia. In addition, people in long-term care settings, like nursing homes, may not have the benefit of a single caretaker who can watch their behavior every day to look for patterns.

About 9.6% of people in the US with Alzheimer's disease or dementia may have PBA—over half a million people.

According to a survey of 499 patients with Alzheimer’s disease (or their caregivers), 9.6% may have PBA. Based on this data, 500,000 people living with Alzheimer's in the United States may also have PBA.†

ALS (Lou Gehrig's Disease)
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ALS (Lou Gehrig's Disease)

PBA episodes can occur at any time during the course of ALS and may be mistaken for depression.

At least 27.5% of people with ALS in the US may have PBA.

According to a survey of 40 patients with ALS (or their caregivers), 27.5% patients with ALS in the US may have PBA.†

Multiple Sclerosis (MS)
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Multiple Sclerosis (MS)

Because MS may produce a wide variety of symptoms, and require different medications to treat them, people with MS who develop sudden, frequent, uncontrollable crying and/or laughing episodes that don’t match how they feel may not always know what’s causing them. That’s why it’s important for patients to describe these episodes to their doctor – how long they last, how the patient feels while they’re happening, and how they affect the patient.

In the US, 9.8% of people with MS (almost 40,000 people) may have PBA.

According to a survey of 504 patients with MS (or their caregivers), 9.8% may have PBA. Based on this data, 40,000 patients with MS in the United States may have PBA.†

Parkinson's Disease
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Parkinson's Disease

Parkinson’s disease is a progressive condition known for its physical symptoms. While it’s important to make adjustments for physical symptoms, don’t forget to talk to a doctor if you or a loved one also have frequent, uncontrollable crying and/or laughing that doesn’t match how they feel.

Over 35,000 people in the US with Parkinson's disease (3.6%) may have PBA.

According to a survey of 449 patients with Parkinson’s disease (or their caregivers), 3.6% may have PBA. Based on this data, 35,000 patients with Parkinson’s disease in the United States may have PBA.†

†Work SS, Colamonico JA, Bradley WG, Kaye RE. Pseudobulbar affect: an under-recognized and under-treated neurological disorder. Adv Ther. 2011;28:586–601.

PBA is different from depression

PBA is not depression. But because sudden, frequent, uncontrollable episodes of crying are a key feature of PBA, people sometimes mistake PBA for depression. It's important to understand that the two are separate conditions. Some people can have both PBA and depression. Both conditions are treatable and should be diagnosed by your doctor§ and managed separately.

 

PBA Depression
Underlying Condition Occurs in people with neurologic conditions such as Stroke, Alzheimer’s disease and Dementia, ALS (Lou Gehrig's Disease), MS (Mutltiple Sclerosis), and Parkinson’s disease, or with brain injury* May or may not have an underlying neurologic condition
Symptoms Sudden, frequent crying, laughing, or both May include crying, loss of interest or pleasure, sad mood, appetite changes, or sleeping too much or too little‡
Episode Control Crying and/or laughing episodes are uncontrollable Crying, if present, may be voluntarily controlled
Expressions vs Feelings Crying and/or laughing are exaggerated or do not match how you feel Outward expression matches feelings or intent
Accompanying Thoughts Episodes may not be related to a happy or depressed mood Crying, if present, matches mood

*This is not a complete list. Other neurologic conditions may be associated with PBA.

§Formal diagnosis of PBA or depression can only be made by a qualified healthcare professional (HCP). These are not all of the diagnostic features of depression or PBA. PBA occurs in the context of a neurologic condition/injury affecting the brain and is not explained by other causes such as medication use.

‡Diagnosis can only be made by a qualified healthcare professional. These are not all the symptoms of depression.

Carol - Patient with Traumatic Brain Injury and PBA, taking NUEDEXTA
Carol
Patient with Traumatic Brain Injury and PBA, taking NUEDEXTA

“When I was diagnosed with PBA, I was so relieved I had a name for it—there was a real thing that was affecting me.”

See Carol’s Story
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Proven to reduce PBA episodes

NUEDEXTA is the first and only treatment approved by the FDA to treat PBA.

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INDICATION and IMPORTANT SAFETY INFORMATION for
NUEDEXTA® (dextromethorphan HBr and quinidine sulfate)

INDICATION:

NUEDEXTA is approved for the treatment of Pseudobulbar Affect (PBA).

PBA is a medical condition that causes involuntary, sudden, and frequent episodes of crying and/or laughing in people living with certain neurologic conditions or brain injury. PBA episodes are typically exaggerated or don’t match how the person feels. PBA is distinct and different from other types of emotional changes caused by neurologic disease or injury.

NUEDEXTA is only available by prescription.

IMPORTANT SAFETY INFORMATION:

Before you take NUEDEXTA, tell your doctor:

  • If you are taking monoamine oxidase inhibitors (MAOIs), quinidine, or quinidine-related drugs. These can interact with NUEDEXTA causing serious side effects. MAOIs cannot be taken within 14 days before or after taking NUEDEXTA.
  • If you have previously had an allergic reaction to dextromethorphan, quinidine or quinidine-like drugs.
  • About all medicines, herbal supplements, and vitamins you take as NUEDEXTA and certain other medicines can interact causing side effects.
  • If you have had heart disease or have a family history of heart rhythm problems. NUEDEXTA may cause serious side effects, including changes in heart rhythm. If you have certain heart problems, NUEDEXTA may not be right for you. Your doctor may test your heart rhythm (heartbeats) before you start NUEDEXTA.
  • If you have myasthenia gravis.

IMPORTANT SAFETY INFORMATION: (Continued)

While taking NUEDEXTA, call your doctor right away:

  • If you feel faint or lose consciousness.
  • If you experience lightheadedness, chills, fever, nausea, or vomiting as these may be signs of an allergic reaction to NUEDEXTA. Hepatitis has been seen in patients taking quinidine, an ingredient in NUEDEXTA.
  • If you have unexplained bleeding or bruising. Quinidine, an ingredient in NUEDEXTA, can cause a reduction in the number of platelets in your blood which can be severe and, if left untreated, can be fatal.
  • If you feel dizzy, since it may increase your risk of falling.
  • If you have muscle twitching, confusion, high blood pressure, fever, restlessness, sweating, or shivering, as these may be signs of a potential drug interaction called serotonin syndrome.

The most common side effects of NUEDEXTA include: diarrhea, dizziness, cough, vomiting, weakness, and swelling of feet and ankles. This is not a complete list of side effects. Tell your doctor about any side effect that bothers you or does not go away.

You are encouraged to report side effects of NUEDEXTA® (dextromethorphan HBr and quinidine sulfate). Please contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 (www.fda.gov/medwatch).

Please read FULL PRESCRIBING INFORMATION.