Edward Kasarskis, M.D., Ph.D. is Director of the multidisciplinary ALS Center at the University of Kentucky Neuroscience Center in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY. 

Dr. Kasarskis

Q: I’ve had ALS for a couple of years and I find I often seem to over-react to something that is either funny or sad. I feel much more emotional than I used to be, and as a tall, large man I find people look at me like I’m crazy. I’ve heard there’s a prescription drug to help. What do you think I can or should do?

A: You are not alone. What you’re experiencing is not uncommon for people with ALS. It also can occur in people with multiple sclerosis, Parkinson’s disease, stroke, traumatic brain injury, and other neurologic conditions.

Before you developed ALS, you naturally and unconsciously were able to link your reaction to the situation at hand. If a joke was just mildly amusing, you may have smiled or giggled rather than laughing loudly or uproariously. If someone referred to a sad situation, you would have frowned or shown concern rather than crying. You may find that you laugh or cry without an obvious stimulus.  Your reactions can indeed be confusing to others and embarrassing as a result.

The term for this is pseudobulbar affect (or PBA). It happens when certain neurological diseases or injuries damage the area of the brain responsible for controlling what we typically consider to be the normal expression of emotion. The damage can affect brain signaling, short circuiting the normal system and causing episodes of involuntary crying or laughing.

Nuedexta,™ the first and only FDA-approved treatment, has been show to significantly reduce the number of PBA episodes for some people. In fact, in a study, half of the people taking the prescription drug had no PBA episodes after they had taken the drug for 10 to 12 weeks. Some experienced a reduction in their daily number of episodes after just a week.

The drug combines dextromethorphan hydrobromide and quinidine sulfate. If your physician prescribes it for you, you will probably be told to take one capsule each morning for the first week, and then increase your dose to two capsules a day, about 12 hours apart. You can take the pills with or without food.

Nuedexta can interact with other medications, so be sure your physician is aware of other medications you’re taking. Some people with heart problems will be asked to have a “baseline” EKG taken before starting Nuedexta. To learn more about Nuedexta, visit neudexta.com. 

If you would like to submit questions for a future Q & A, please send your questions to Amber Walters at awalters@alsa-national.org. Please understand that we won’t be able to address all questions and we won’t be able to respond to individuals personally.