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Failure to Diagnose Psuedobulbar Following Brain Injury

Kingston Personal Injury Attorney

Each year, approximately 800,000 Americans suffer non-traumatic (or acquired) brain injuries and another 1.7 million Americans suffer a traumatic brain injury. Brain injuries are a serious public health problem because of their associated long-term disabilities. One of the consequences of brain injury is the pseudobulbar affect.

Often referred to as involuntary emotional expression disorder, or emotional incontinence, pseudobulbar generally occurs secondary to brain injury or neurologic conditions. Its true pathophysiology remains a mystery, but medical professionals associate the disorder with loss of regulatory control by the frontal lobes and/or brain stem damage. Characterized by sudden outbursts of involuntary crying and/or laughing, patient may experience exaggerated expressions contrary to the sufferer’s actual emotional state.

It’s estimated that nearly 1.5 million people in America suffer from the condition; however, many believe that the actual prevalence of the condition may be higher. One of the issues with quantifying prevalence may be that the presence of psuedobulbar is difficult to diagnose.

Psuedobulbar can be confused with other conditions because it is associated with such debilitating diseases like traumatic brain injury (TBI.) In the case of TBI, precipitating injuries can include concussions, skull fractures, contusions, brain injuries from birth, shaken baby syndrome, shearing, oxygen deprivation and hematomas. Doctors have mistaken symptoms of psuedobulbar with depression and anxiety.

Lack of clinical familiarity is only one of the issues regarding accurate diagnosis. The condition is not included in either the American Psychiatric Society’s Diagnostic and Statistical Manual of Mental of Mental Disorders or the National Center for Health Statistics and the Centers for Medicare and Medicaid Services’ International Classification of Diseases. Also, psuedobulbar has not gained the same recognition or study that other neuropsychiatric conditions have undergone.

In the past, treatment involved anti-depressants. As of November 2010, the Food and Drug Administration had approved Nuedexta, produced by Avanir Pharmaceuticals. To date, this drug remained the first and only psuedobulbar-specific drug therapy.

Little is known about the neurological condition. Associated with TBI and other conditions, psuedobulbar, if misdiagnosed and untreated, can cause lasting psychological harm.