Description, Causes and Risk Factors:
Paralysis of the lips and tongue, simulating progressive bulbar paralysis, but due to supranuclear lesions with bilateral involvement of the upper motor neurons; characterized by speech and swallowing difficulties, emotional instability, and spasmodic, mirthless laughter.
Pseudobulbar palsy occurs when nervous system conditions cause degeneration of certain motor nuclei that exit the brain stem.
Patients with pseudobulbar palsy have progressive difficulty with activities that require the use of muscles in the head and neck that are controlled by particular cranial nerves. The first noticeable symptom is often slurred speech. Over time, speech, chewing, and swallowing become progressively more difficult, eventually becoming impossible. Sudden emotional outbursts, in which the patient spontaneously and without cause begins to laugh or cry, are also a characteristic of pseudobulbar palsy.
The prognosis for pseudobulbar palsy is quite poor. When the symptoms progress to disability, there is a high risk of choking and aspiration (breathing food or liquids into the lungs), which can lead to severe pneumonia and death. The conditions with which pseudobulbar palsy is associated also have a high risk of progression to death.
This condition can be caused by a number of things. Strokes, infections, and tumors can all lead to lesions among the high motor neurons. Progressive neurological diseases like Parkinson's disease and amyotrophic lateral sclerosis have also been linked with pseudobulbar palsy. Medical imaging studies of the brain can reveal changes and provide information about the extent of the damage.
Signs and symptoms of pseudobulbar palsy include:
Small, stiff and spastic tongue.
Slow and indistinct speech.
Brisk jaw jerk.
Gag reflex may be normal, exaggerated or absent.
Examination may reveal upper motor neuron lesion of the limbs.
Dysphagia (difficulty in swallowing).
Diagnosis of pseudobulbar palsy is based on observation of the symptoms of the condition. Tests examining jaw jerk and gag reflex can also be performed. It has been suggested that the majority of patients with pathological laughter and crying have pseudobulbar palsy due to bilateral corticobulbar lesions and often a bipyrimidal involvement of arms and legs.To further confirm the condition, MRI can be performed to define the areas of brain abnormality.
Management of pseudobulbar palsy may include physical therapy to help patients retain strength and control over their muscles for as long as possible, along with the development of alternative communication methods so patients can communicate if their speech becomes unintelligible. Sign language and communication boards may be used, and patients can also work with devices intended to generate speech mechanically. For infections, medications can be provided to kill infectious organisms and patients may be provided with supportive care like suction to keep the throat clear and reduce the risk of aspirating fluids.
Treatment of neurological conditions like pseudobulbar palsy is constantly undergoing refinements as doctors learn more about the brain and its processes. Patients diagnosed with this condition may want to seek advice from a specialist to get information on the latest options for managing the disease. It may be possible to enroll in an experimental study and get access to new treatments not yet available to members of the general public. Participation in studies can also provide patients with an opportunity to interact with other patients who have the disease and people may have supportive advice and information for fellow study participants.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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