From the Guidelines
Pseudobulbar palsy and bulbar palsy are distinct neurological conditions that differ in their anatomical location of damage, resulting clinical manifestations, and impact on morbidity, mortality, and quality of life. The primary difference between pseudobulbar palsy and bulbar palsy lies in the level of damage to the nervous system. Pseudobulbar palsy results from damage to the upper motor neurons in the corticobulbar tracts, typically above the level of the brainstem, while bulbar palsy involves damage to the lower motor neurons in the brainstem nuclei or their cranial nerves 1.
Clinical Manifestations
The clinical presentations of pseudobulbar palsy and bulbar palsy are distinct. Pseudobulbar palsy is characterized by spastic paralysis with hyperactive reflexes, pathological reflexes, and emotional lability, including uncontrollable laughing or crying, which can be a cause for frustration and concern for the patient and family 1. In contrast, bulbar palsy presents with flaccid paralysis, muscle atrophy, fasciculations, and absent reflexes.
Impact on Functions
Both conditions affect similar functions, including speech, swallowing, and facial movements. However, pseudobulbar palsy often preserves some function due to the upper motor neuron involvement, while bulbar palsy typically causes more severe weakness and atrophy. The distinction between these two conditions is crucial for determining the underlying cause and guiding treatment, as pseudobulbar palsy often results from bilateral strokes, multiple sclerosis, or motor neuron disease affecting upper neurons, while bulbar palsy commonly stems from conditions like myasthenia gravis, Guillain-Barré syndrome, or motor neuron disease affecting lower neurons.
Management and Treatment
In the management of these conditions, particularly when emotional lability interferes with patient rehabilitation or complicates relationships with family members, pharmacotherapy may be considered, with antidepressant medication showing efficacy in treating extreme symptoms of emotional change, such as pathological affect or pseudobulbar affect 1. Patient and family education is also very important to address the emotional and psychological impacts of these conditions.
From the Research
Definition and Characteristics
- Pseudobulbar affect (PBA) is characterized by uncontrollable, inappropriate laughing and/or crying that is either unrelated or out of proportion to the emotions felt by the patient 2, 3, 4, 5, 6
- It occurs in patients with neurological disorders, such as amyotrophic lateral sclerosis (ALS), multiple sclerosis, or traumatic brain injury 2, 3, 4, 5, 6
Difference between Pseudobulbar Palsy and Bulbar Palsy
- There is no direct information in the provided studies to distinguish between pseudobulbar (false bulbar) palsy and bulbar palsy
- However, pseudobulbar affect is often associated with upper motor neuron injuries or illnesses, which may be related to pseudobulbar palsy 6
- Bulbar palsy, on the other hand, typically refers to a condition affecting the brainstem, which can result in difficulties with speech, swallowing, and other functions
Treatment and Management
- Dextromethorphan/quinidine is a combination product indicated for the treatment of pseudobulbar affect 2, 3, 4, 5
- Traditional pharmacological treatment of pseudobulbar affect is largely comprised of antidepressant therapy, including tricyclic antidepressants and selective serotonin reuptake inhibitors 3
- However, the efficacy of these treatments is not well established, and dextromethorphan/quinidine has been shown to be effective in reducing the frequency and severity of pseudobulbar affect episodes 2, 3, 4, 5