What Is Pseudobulbar Palsy? Causes, Symptoms And Treatment

Pseudobulbar palsy is a neurological condition in which the person losses control over his facial movements. Palsy is term closely linked with paralysis where there is loss of sensation in a body part accompanied with loss of control of movement. In pseudobulbar palsy because of facial muscle paralysis, patient experiences difficulty in chewing, speaking, swallowing etc.

Pseudobulbar palsy is upper motor neuron palsy where the cells of cortical tract of certain cranial nerves are damaged. Any condition which causes damage to the cells of cortical tract may lead to pseudobulbar palsy. Hence this condition is often seen in patients suffering from stroke, tumor in brain stem, multiple sclerosis, infection in brain etc.

Person suffering from pseudobulbar palsy usually experiences difficulty in living his daily life, since he finds difficulty in speaking, eating or swallowing. There is something called uncontrolled emotional outburst where patient does not have control over laughing or crying. There is no specific treatment for pseudobulbar palsy. Treatment is to address the underlying cause.

Symptoms Of Pseudobulbar Palsy

Pseudobulbar palsy usually affects people over the age of 70 years. However, sometimes it can also occur at an early age. The earliest symptom patient develops is spastic –slurred dysarthria. This means patient finds difficulty in articulating words due to impairment of muscles used while speaking.

Over a period of time there is dysphagia with choking on liquids and food as the reflexes of palate and pharynx are not preserved.

The tongue lies on the floor of mouth with poor movement. It becomes smaller in size and tight. The muscles of mastication and facial muscles are spastic with exaggerated jaw jerk and brisk facial reflexes. Patient loses control over emotional expressions and hence there are spontaneous bouts of crying or laughing without any reason. Spasm of vocal cord produces abnormal change in voice.

What Are The Causes Pseudobulbar Palsy?

There are several causes that may lead to development of pseudobulbar palsy. However, the important among them are conditions and diseases that affect the transmission of nerve signals from cerebral cortex to the lower brain stem. Cerebral cortex is involved in many activities mainly it deals with motor activities such as talking, walking jumping etc and sense of touch and smell.

The brain stem controls several nerves, especially the cranial nerves situated on face. These nerves have different functions to play. When the signals from cerebral cortex to the lower brain stem are hampered, patient loses ability to control his facial movements and expressions. Following are the etiological factors such as:

  • Stroke multiple or recurrent.
  • Head injury
  • Malignancy or tumor in the high brain stem.
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis.
  • Progressive supranuclear palsy.
  • Alzheimer disease

Diagnosis And Treatment Of Pseudobulbar Palsy

Pseudobulbar palsy is easily diagnosed by the doctor from the abnormal facial features and symptoms during medical examination. However, sometimes it can be misdiagnosed as depressive disorder if the emotional features such as crying or laughing are prominent. The probable diagnosis is confirmed with MRI imaging as it indicates the underlying etiology.

There is no particular treatment that will help to reverse the condition. The main aim is to address the underlying cause. Treatment is mainly supportive. For example anticholinergic medicines are useful to control drooling.

For patients suffering from dysphagia, percutaneous endoscopic gastrostomy tube is used. Patient may also need speech and language therapy to correct his slurred speech.