Life With ALS.com
+ Diagnosed Aug 2005
+ Bipap March 2007
+ PEG July 2007
+ Trache and Vent July 2008
Still Living, Loving & Laughing
As you should know, Emotional Lability (Pseudobulbar affect) is a symptom of ALS and the person has absolutely no control over it. It is defined as the inappropriate and uncontrollable out breaking of either crying, laughter or anger. It is not a case of frustration or anger being intense. I have never taken medication for anything my whole life and I have always been able to control my emotions and reactions to outside events. Not now! I could not believe I could not control this, but I had to start taking medication for it and after the first pill everything was back to normal. I started taking Citalopram, it has worked for me. There are many other medications that can be taken that are equally effective.
I have to be honest here and say that this problem was really hard on my family, and me, before recognizing what was happening and getting it under control.
This is probably the most misunderstood and embarrassing symptoms of ALS.
I am constantly trying to explain this to fellow PALS and their caregivers. It is a hard thing for caregivers to accept, they typically scold their PALS and tell them to get a grip on their emotions. Or to quit being so mean!
It is very hard to realize that a person with ALS can’t control this behaviour.
It has broken up too many families and, if recognized for what it is, can be controlled easily with the proper medication.
The following is from http://encyclopedia.thefreedictionary.com/emotional+lability
Labile affect or Pseudobulbar affect refers to the pathological expression of laughter, crying, or smiling. It is also known as "Emotional Lability", "Pathological Laughter and Crying", "Emotional Incontinence", or, more recently, "Involuntary Emotional Expression Disorder (IEED)". [1] Patients may find themselves laughing uncontrollably at something that is only moderately funny, being unable to stop themselves for several minutes. Episodes may also be mood-incongruent; a patient might laugh uncontrollably when angry or frustrated, for example.
Labile affect is most commonly observed after brain injury or degeneration in Amyotrophic lateral sclerosis (also known as motor neuron disease or Lou Gehrig's Disease). It affects up to 50% of patients or up to 17,000 people, particularly those with pseudobulbar palsy. [2]
While not as profoundly disabling as the physical symptoms of these diseases, labile affect can have a significant impact on individuals' social functioning and their relationships with others. In a disease such as Motor Neuron Disease, the majority of patients are cognitively normal; however, the appearance of uncontrollable emotions is commonly associated with learning disabilities. This may lead to severe embarrassment and avoidance of social interactions for the patient, which in turn has an impact on their coping mechanisms and their careers.
Treatment for labile affect is usually pharmacological, using anti-depressants such as fluoxetine, citalopram, or amitriptyline in low to moderate doses. In the USA, a combination of dextromethorphan and a subtherapeutic dose of quinidine has been submitted to the FDA for approval to treat emotional lability.
