Inappropriate Affect (also known as pseudo bulbar affect, emotional incontinence, involuntary emotional expression disorder-IEED)
Uncontrolled or involuntary laughter and/or crying can be a distressing symptom in MS. Once it starts, it can be very hard to stop. This can cause distress and much embarrassment for the person experiencing it, and can also result in mistaken information cues for the person observing it. It can occur in up to 10% of people with MS. It is thought to be related to lesions in the cortex responsible for emotional control aspects, the bulbar nuclei, the physiological effector, and the hypothalamus which integrates the two. In this context, people can exhibit sudden and exaggerated expressions of emotion (laughter and crying) that may or may not be demonstrative of their mood at the time. This condition, though not caused by depression, can be effectively treated with relatively small doses of a number of drugs including some members of the tricyclic and SSRI families.
Symptom Management:
If bothersome, this is managed by medication. It is also important to be vigilant for other symptoms that may indicate depression is also present.
Other Resources:
An MS Society of Canada website that provides information on a variety of topics. Information is provided by a range of North American experts who respond to inquires from individuals affected by MS.
