January 21, 2004
In 1872, naturalist Charles Darwin described a strange disorder that causes people to laugh or cry uncontrollably.
Now there may be a drug to treat the baffling condition, variably known as pseudobulbar affect, emotional liability and emotional incontinence.
Pseudobulbar affect can be mild in some patients, debilitating in others. Doctors tell of a minister who broke into tears every time she talked to a church member. Another patient would laugh every time he talked, so he began communicating with a pad and pencil. Another patient laughed so hard he threw up.
Susie Chesler of north suburban Deerfield said the silliest joke would cause her to laugh hysterically for 10 minutes. Worse, she would cry three or four times a day.
But she has gotten her emotions under control with the experimental drug, AVP-923. "I used to panic and go crazy with emotions," she said. "Now if I get sad, I don't cry or get hysterical."
Northbrook-based Consultants in Neurology and other centers are conducting clinical trials on the drug, made by Avanir Pharmaceuticals. Although the studies haven't been completed and the drug hasn't been approved by the Food and Drug Administration, early results are promising, researchers say.
The condition can affect people with strokes, brain injuries and neurological disorders such as multiple sclerosis and Lou Gehrig's, Alzheimer's and Parkinson's diseases. Chesler, for example, has MS.
The cause appears to be related to injuries to pathways of the brain that allow people to control their emotions. Some people quit work and stop going out in public. Antidepressants can help, but many patients don't like the side effects.
The twice-a-day pill consists of dextromethorphan, the active ingredient of over-the-counter cough medicines, and quinidine, a prescription drug that slows the body's absorption of dextromethorphan. Side effects include fatigue, dizziness, nausea and headache.
"It makes the brain work more normally," said Chesler's doctor, Dr. Daniel Wynn.
But not all patients need drugs, said University of Chicago neurologist
Dr. Raymond Roos. Sometimes, simply explaining the nature of the condition
to the patient, family and friends helps to ease the embarrassment, Roos
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