A case study published in the Journal of Medical Case Reports highlights the successful treatment of a patient with pseudobulbar affect (PBA) with a history of traumatic brain injury.

In this case, a 62-year-old White male with several neurovascular and psychiatric conditions suffered a work-related head injury, which steadily lead to years of experiencing painful, intractable headaches. The researchers noted that despite the best efforts of his physicians, these headaches soon became debilitating and made it difficult for the patient to hold a steady job. For the next 30 years, he struggled to manage his injury, eventually becoming homeless. Subsequently, upon hospital visit, he was diagnosed with major depressive disorder and was administered amitriptyline, which he has taken since.

The patient eventually suffered a stroke and began experiencing episodes of inappropriate laughing and crying and a general loss of emotional control. He was then diagnosed with PBA. In addition to taking amitriptyline, the patient was given antidepressants, which offered no symptom reprieve. The patient became increasingly antisocial. In 2017, following years of unsuccessful pharmacotherapy, he was placed on dextromethorphan/quinidine (DM/Q) 30 mg by mouth twice daily. This treatment has markedly improved his quality of life, and he is recently married and living comfortably, with the help of government benefits. He has recovered almost full speech and regained his social confidence.

“This case provides anecdotal evidence for the efficacy of DM/Q in the treatment of PBA, with a remarkably swift and complete cessation of symptoms in an acutely affected patient,” the researchers concluded.

Link: https://pubmed.ncbi.nlm.nih.gov/33272325/

Keywords: Case report, Dextromethorphan/quinidine, Emotional incontinence, Pseudobulbar affect, Stroke