New Drug And Uncontrolled Tear, Laughter Outbreaks


Scientists have developed a trial medication that is believed to be useful for people enduring an obscure disorder that results in repeated and uncontrolled outburst of laughter or crying. The medical condition called pseudo bulbar affect (briefly known as PBA) frequently have an effect on people having brain damage and deteriorating neurological disarrangement like multiple sclerosis (a disease that removes the myelin sheath from the nerves and is distinguished by patches of firmed tissue in the brain or the spinal cord) or amyotrophic lateral sclerosis (a rare fatal progressive degenerative ailment that affects pyramidal motor neurons) and is also referred to as Lou Gehrig's disease.

The experimental medication is said to be a blend of dextromethorphan and a minor dose of quinidine. According to Dr. Erik Pioro, the co-author of the study, who is also the director of the Section for ALS and Related Disorders at the Cleveland Clinic in Cleveland in Ohio, the clinical trials demonstrated that the patients who were administered this experimental drug witnessed considerable lessening in the number as well as the harshness of such occurrences. Dr. Pioro, who was born in Saskatchewan in Canada, further stated that the frequent outbursts of laughter or crying during wrong times is likely to have a harsh effect both on the well-being, social performance and the class of life of the patient as well as the minder. The findings of the study on the subject were presented by Dr. Pioro at the annual conference of the American Academy of Neurology held recently in Toronto.

Referring to an incident where laughter and giggling prevailed over a patient suffering from the PBA while attending a funeral - a reaction that is totally in variation with the situation, Dr. Pioro said that the problem with pseudo bulbar affect is that while the society does not approve of the expressions of the PBA patients, sometimes they are not aware of this reality. Hence, it is very natural that consequently such patients may turn out to be introverted socially and this causes their social life to deteriorate. Patients, who are aware that their behaviour is not acceptable to the society and know where such episodes may occur, usually keep away from such situation. Thus, Dr. Pioro emphasizes that such a situation has a very great effect on the social communications of these patients.

Unfortunately enough, till date there is no precise cure for the disorder called pseudo bulbar affect (PBA). Presently, the only medications available for treating PBA are a few antidepressant drugs - while some patients use the outmoded tricyclics, such as amitriptyline, others are prescribed the latest selective serotonin re-uptake inhibitors (SSRIs), such as Paxil or Prozac. However, Dr. Pioro is of the view that none of these drugs are useful for several people suffering from PBA.

The new experimental drug has been named DMQ since it is a blend of dextromethorphan and quinidine. If Dr. Pioro is to be believed, this new medication seems to bring a new ray of hope for the PBA patients, most of whom are languishing in the absence of any effective treatment for the disease. Meanwhile, scientists will soon present the findings of the two studies conducted on the subject as a part of their submission to the United States Food and Drug Administration (FDA) for the approval of the experimental drug DMQ for general use among the PBA patients. In addition, they would be required to submit a parallel application to the Health Canada for endorsement so that the drug may be sold in this country too.

According to Dr. Pioro, their study was divided into two phases. In the first phase of the study lasting for 12 weeks, the scientists evaluated different dosage of DMQ alongside a placebo. In the second phase, an 'open-label' study, the research participants were given DMQ for an additional period of 12 weeks. In all 283 people participated in the first phase of the study and among them 253 persons (around 89 per cent) opted to participate in the second phase of the research too.

All the subjects of the study were provided with a treatment of DMQ dosage every day and often subjected to an examination that enabled to evaluate the rate of recurrence as well as the harshness of their pseudo bulbar affect (PBA). During the course of the study, the researchers discovered that the mean score had considerably progressed between the period from the commencement of the study and the completion of the 'open-label' study. According to Dr. Pioro, it was found that PBA patients who were given placebo in the earlier clinical trial and later changed to DMQ demonstrated the maximum development.

Dr. Pioro said that the findings of their studies signify the maiden long-standing consequences demonstrating that the new drug DMQ is useful in controlling the incapacitating condition badly affecting the patients suffering from neurologic ailments and damages. At the same time, he pointed out that presently there is no treatment for the PBA patients that has been approved by the FDA. This is a major problem since using off-label treatments are either usually unproductive or may result in undesirable side effects.


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