Contributions
Abstract: EP1380
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS symptoms
Introduction: Pseudobulbar affect (PBA) denotes involuntary laughter or crying disconnected from or incongruent with experienced emotion. In multiple sclerosis (MS), PBA results from disrupted limbic and paralimbic networks modulated by the cerebellum. Increased PBA recognition and available pharmacotherapeutics raise expectations that clinicians diagnose and treat PBA. However, prevalence estimates ranging from 3.0 to 46.2% suggest widespread ascertainment error.
Objectives: Determine prevalence of PBA in an academic MS center.
Methods: Consecutive patients with >6 months of MS followed in the University of Alabama MS clinic from 1 June through 30 September 2017 completed a one-time survey. PBA was ascertained by physician impression and the subject-completed Center for Neurologic Study-Lability Scale (CNS-LS). Depression was determined by physician impression and the Patient Health Questionnaire-9 (PHQ9). Published cut-offs for scales dichotomized presence or absence of PBA and depression.
Prevalence rates of PBA and depression were calculated by physician impression and cut-offs for CNS-LS (>=13, 17, and 21) and PHQ9 (>=10). Correlations between diagnostic methods were assessed with chi-square, and associations between diagnoses, demographics, and MS disease characteristics were tested using chi-square or t-tests, as appropriate. All statistical analyses were performed using JMP 13.0.
Results: Seventy-four subjects completed surveys. Clinicians identified PBA in 2 subjects (2.7%) and depression in 33 (45.2%). Using the CNS-LS, PBA prevalence decreased with increasing cutoff score (>= 13: 39.2%; >= 17: 27.0%; >=21: 13.5%).
The PHQ9 identified depression in 28 subjects (39.2%). Agreement between clinician-perceived depression and PHQ9-criterion depression was 48.5%, while agreement between subject experienced depression and PHQ9 was higher at 58.6%. When subjects with depression by PHQ9 were excluded, PBA prevalence fell across all CNS-LS cutoffs (>=13: 18.9%; >=17: 9.5%; >=21: 5.4%).
Conclusions: Despite published criteria for PBA, consistent methods to recognize PBA remain elusive. Physicians diagnosed very little PBA in this cohort, possibly due to under-recognition, over-estimation by the CNS-LS, or greater attention paid to depression or other factors. Symptom overlap between PBA and depression may increase misdiagnosis. Communication with patients and contextual interpretation of scales are essential for diagnosing affective disorders in MS.
Disclosure: Ramon Reddick: Nothing to disclose
John R Rinker, II: Research support from Biogen Idec, not relevant to this study.
Abstract: EP1380
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS symptoms
Introduction: Pseudobulbar affect (PBA) denotes involuntary laughter or crying disconnected from or incongruent with experienced emotion. In multiple sclerosis (MS), PBA results from disrupted limbic and paralimbic networks modulated by the cerebellum. Increased PBA recognition and available pharmacotherapeutics raise expectations that clinicians diagnose and treat PBA. However, prevalence estimates ranging from 3.0 to 46.2% suggest widespread ascertainment error.
Objectives: Determine prevalence of PBA in an academic MS center.
Methods: Consecutive patients with >6 months of MS followed in the University of Alabama MS clinic from 1 June through 30 September 2017 completed a one-time survey. PBA was ascertained by physician impression and the subject-completed Center for Neurologic Study-Lability Scale (CNS-LS). Depression was determined by physician impression and the Patient Health Questionnaire-9 (PHQ9). Published cut-offs for scales dichotomized presence or absence of PBA and depression.
Prevalence rates of PBA and depression were calculated by physician impression and cut-offs for CNS-LS (>=13, 17, and 21) and PHQ9 (>=10). Correlations between diagnostic methods were assessed with chi-square, and associations between diagnoses, demographics, and MS disease characteristics were tested using chi-square or t-tests, as appropriate. All statistical analyses were performed using JMP 13.0.
Results: Seventy-four subjects completed surveys. Clinicians identified PBA in 2 subjects (2.7%) and depression in 33 (45.2%). Using the CNS-LS, PBA prevalence decreased with increasing cutoff score (>= 13: 39.2%; >= 17: 27.0%; >=21: 13.5%).
The PHQ9 identified depression in 28 subjects (39.2%). Agreement between clinician-perceived depression and PHQ9-criterion depression was 48.5%, while agreement between subject experienced depression and PHQ9 was higher at 58.6%. When subjects with depression by PHQ9 were excluded, PBA prevalence fell across all CNS-LS cutoffs (>=13: 18.9%; >=17: 9.5%; >=21: 5.4%).
Conclusions: Despite published criteria for PBA, consistent methods to recognize PBA remain elusive. Physicians diagnosed very little PBA in this cohort, possibly due to under-recognition, over-estimation by the CNS-LS, or greater attention paid to depression or other factors. Symptom overlap between PBA and depression may increase misdiagnosis. Communication with patients and contextual interpretation of scales are essential for diagnosing affective disorders in MS.
Disclosure: Ramon Reddick: Nothing to disclose
John R Rinker, II: Research support from Biogen Idec, not relevant to this study.