Pseudobulbar Palsy, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

Pseudobulbar Palsy (PBP) is a medical disorder in which a person loses control of facial muscles and has trouble chewing or speaking
This can be caused by a range of neurological disorders.
Patients with Pseudobulbar Palsy have:
1. Difficulty chewing and swallowing;
2. Spasticity in the tongue and bulbar regions.
3. Slurred speech.
They occasionally may also show uncontrolled emotional outbursts.
Causes
Pseudobulbar Palsy (PBP) is normally produced by injury to neurons of brainstem, specifically the corticobulbar tract.
Pseudobulbar palsy occurs from illness of the corticobulbar tracts.
Bilateral tract injuries must occur for medically present disease as the muscles are bilaterally innervated.
Pseudobulbar Palsy is produced as a result of some type of injury to motor fibers traveling from cerebral cortex to lower brainstem.
This injury may be due to a range of neurological disorders affecting demyelination and bilateral corticobulbar disorders.
Some of the disease factors which can produce Pseudobulbar Palsy are:
1. Progressive supra-nuclear palsy
2. Amyotrophic Lateral Sclerosis
3. Parkinson's disease
4. Motor neuron diseases
5. Multiple sclerosis
6. Brainstem tumors
7. Neurological involvement in the case of Behcet's disease
8. Injury to the brain
a. Cerebrovascular events - e.g., bilateral internal capsule infarcts.
b. Demyelinating disorders - e.g., multiple sclerosis.
c. Motor neuron disease.
d. High brainstem tumors.
e. Head injury.
f. Neurosyphilis.
In motor neuron disease it is frequent to see both bulbar and pseudobulbar palsies.
Symptoms of Pseudobulbar Palsy are:
1. Slurred speech
2. Dysphagia (difficulty in swallowing)
3. Tongue spasticity
4. Brisk jaw jerk
5. Dysarthria
6. Labile affect
Signs:
1. Tongue - paralyzed; no wasting initially and no fasciculations; 'Donald Duck' speech; unable to protrude tongue.
2. Palatal movements absent.
3. Dribbling persistently.
4. Facial muscles - may also be paralyzed.
5. Reflexes - exaggerated (e.g., jaw jerk).
6. Nasal regurgitation may be present.
7. Dysphonia.
8. Dysphagia.
10. Emotional liability may also be present.
There may also be neurological deficits in the limb - e.g., raised tone, improved reflexes and weakness.
A confirmatory diagnosis of Pseudobulbar Palsy is dependent on the symptoms that a patient is having
The MRI can also be done to look at the regions of anomalies in the brain.
New developments in technology have led to the use of neurophysiological investigations to assess various aspects of speech dysfunction
A bulbar palsy is a lower motor neuron lesion of cranial nerves IX, X and XII.
A pseudobulbar palsy is an upper motor neuron lesion of cranial nerves IX, X and XII.
Since Pseudobulbar Palsy is produced as a result of some other underlying disease cause, hence treating the underlying cause normally treats Pseudobulbar Palsy.
Medicines which can be used for Pseudobulbar Palsy are:
1. Tricyclic antidepressants,
2. SSRIs.
There has been a new method to treat Pseudobulbar Palsy which uses dextromethorphan along with quinidine sulfate.
All patients should be sent to neurologists for examination
Treatment will depend and directed to the underlying cause
Postural alterations can help with drooling of saliva
They may prevent aspiration.
Supportive measures may have:
1. Baclofen for spasticity,
2. Anticholinergics for drooling,
3. Treatment of aspiration pneumonia if it occurs and
4. Attention to nutrition - e.g., enteral feeding
Treatment should require:
1. Speech therapists
2. Language therapists and
3. The dietician.
Most causes of pseudobulbar palsy is from the brain such as stroke or a burst aneurym or brainstem tumor.
Some need surgery.

TABLE OF CONTENT
Introduction
Chapter 1 Pseudobulbar Palsy
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Bell’s Palsy
Chapter 8 Trigeminal Neuralgia
Epilogue