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Neuroanatomy of pseudobulbar affect

A quantitative MRI study in multiple sclerosis

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Abstract

Pseudobulbar affect (PBA) is defined as episodes of involuntary crying, laughing, or both in the absence of a matching subjective mood state. This neuropsychiatric syndrome can be found in a number of neurological disorders including multiple sclerosis (MS). The aim of this study was to identify neuroanatomical correlates of PBA in multiple sclerosis (MS) using a case-control 1.5T MRI study. MS patients with (n = 14) and without (n = 14) PBA were matched on demographic, disease course, and disability variables. Comorbid psychiatric disorders including depressive and anxiety disorders were absent. Hypo- and hyperintense lesion volumes plus measurements of atrophy were obtained and localized anatomically according to parcellated brain regions. Between-group statistical comparisons were undertaken with α set at 0.01 for the primary analysis. Discrete differences in lesion volume were noted in six regions: Brainstem hypointense lesions, bilateral inferior parietal and medial inferior frontal hyperintense lesions, and right medial superior frontal hyperintense lesions were all significantly higher in the PBA group. A logistic regression model identified four of these variables (brainstem hypointense, left inferior parietal hyperintense, and left and right medial inferior frontal hyperintense lesion volumes) that accounted for 70% of the variance when it came to explaining the presence of PBA. In conclusion, MS patients with PBA have a distinct distribution of brain lesions when compared to a matched MS sample without PBA. The lesion data support a widely-dispersed neural network involving frontal, parietal, and brainstem regions in the pathophysiology of PBA.

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Authors and Affiliations

  1. Neuropsychiatry Division, Dept. of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, FG08-2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada

    O. Ghaffar MD, MSc, L. Chamelian MD, FRCPC & A. Feinstein MPhil, PhD, FRCPC

Authors
  1. O. Ghaffar MD, MSc
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  2. L. Chamelian MD, FRCPC
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  3. A. Feinstein MPhil, PhD, FRCPC
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Correspondence to A. Feinstein MPhil, PhD, FRCPC.

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Ghaffar, O., Chamelian, L. & Feinstein, A. Neuroanatomy of pseudobulbar affect. J Neurol 255, 406–412 (2008). https://doi.org/10.1007/s00415-008-0685-1

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  • DOI: https://doi.org/10.1007/s00415-008-0685-1

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