Real Story:

A devoted husband who supports his wife

Caring for a loved one who lives with Multiple Sclerosis (MS) can be challenging. Watching his wife Karen also struggle with sudden, frequent, unpredictable, and exaggerated crying or laughing episodes was even more difficult.

Karen was already diagnosed with MS for years before she and Ross met and got married. Even for a practicing physician like Ross, her crying and laughing episodes remained unexplained. But together, they kept searching until they found an answer.

Ross, caregiver for Karen, patient with Multiple Sclerosis and PBA, taking NUEDEXTA.

Ross, caregiver for Karen, patient with Multiple Sclerosis and PBA, taking NUEDEXTA.

Ross holding camera while Karen kisses his forehead
Caregiver for Karen, patient with Multiple Sclerosis and PBA, taking NUEDEXTA.

“I used to constantly try to be careful so that I didn’t say something wrong or provoke a crying or laughing episode that could be difficult to manage.”

Life with undiagnosed PBA was stressful

Karen’s doctors saw her uncontrollable crying episodes as a symptom of depression resulting from the burden of MS. As a doctor, Ross understood their thinking. “Karen was living with unpredictable crying and laughing episodes,” says Ross. 

Despite Ross and Karen's general happiness, some days were frustrating. “Karen was going through these unpredictable episodes of uncontrollable crying or laughing so frequently, and that just makes anyone irritable. It’s a constant grind,” says Ross. He remained positive despite the tension her unpredictable episodes caused in their relationship. “I used to tell Karen, ‘This isn’t you. This is not a normal response from you.’”


Seeing results with NUEDEXTA

When Ross and Karen discovered a condition called PBA (Pseudobulbar Affect) through an MS forum, they were thrilled to find a 2009 clinical trial specifically for PBA—studying the treatment now called NUEDEXTA.

“It’s important to understand that a person with PBA is not trying to be difficult, they’re not trying to be solitary, they’re not trying to be anti-social, they’re not trying to be cranky – they’re just coping with their PBA symptoms.”

- Ross
Photo of Ross

Through that study, Karen was officially diagnosed with PBA. She’s been taking NUEDEXTA to reduce her PBA episodes since it became available for prescription in 2010, under the supervision of her doctor. Consistency is important, Ross tells us. “I want other caregivers to make sure that their loved ones take the medicine as prescribed by their doctor because that does help a lot.”

Guidance from a caregiver

If you care for someone with a neurologic condition or brain injury and you think they might have PBA, Ross has some advice: Go ahead and help that person seek diagnosis and treatment from a doctor. “As a caregiver, you have to encourage them to get the help they need from doctors and discuss an appropriate treatment,” he says. “I want to tell people to share their crying and laughing symptoms with a doctor and ask if it could be PBA. You have to get a diagnosis from a doctor to get on treatment.”

More stories

Photo of Carol

After an accident that caused a Traumatic Brain Injury, Carol began to cry uncontrollably without feeling sad. She was on a mission to find out why. Her PBA diagnosis was the key.

Photo of Robert

Robert lived with uncontrollable crying symptoms for decades after sustaining a Traumatic Brain Injury in the military. Getting his PBA diagnosis was a major milestone.

Photo of Karen

While she was learning to live with Multiple Sclerosis, uncontrollable crying and laughing epsiodes impacted Karen's life. After years of misdiagnoses, she was correctly diagnosed with PBA and was prescribed NUEDEXTA.

Send Me PBA Conversation Cards

Prepare yourself and the people close to you to talk about the impact of PBA on your lives. Then, talk to your doctor.

Understand the treatment

Learn how to take NUEDEXTA and what to expect during treatment, and review important safety information.


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.


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.


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

are 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 negative side effects of prescription drugs to the FDA.

Visit or call 800-FDA-1088.

Please refer to Full Prescribing Information.