Dextromethorphan/Quinidine for Pseudobulbar Affect Following Stroke: Safety and Effectiveness in the PRISM II Trial

Zorowitz, Richard D.; Alexander, David N.; Formella, Andrea E.; Ledon, Fred; Davis, Charles S.; Siffert, João

doi:10.1016/j.pmrj.2018.06.003

Cited by 6 publications

(3 citation statements)

References 33 publications

(49 reference statements)

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“…All the study participants received DM/Q, 20/10 mg twice daily. Studies have evaluated fluoxetine, paroxetine, and citalopram trials in stroke patients with pseudobulbar affect with reduced severity and episode rates [10]. However, in the PRISM II trials, the dextromethorphan/quinidine medication showed improvement in the different efficacy scales that were used, including Neurologic Study-Lability Scale (CNS-LS) as primary efficacy measures, and the Clinical and Patient/Caregiver Global Impression of Change (CGI-C and PGI-C), Quality of Life-Visual Analog Scale (QOL-VAS), Patient Health Questionnaire (PHQ-9), and the Mini-Mental State Examination (MMSE).…”

Section: Discussionmentioning

confidence: 99%

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

Espiridion¹,

Risos

2018

Cureus

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Pseudobulbar affect is a condition that presents as involuntary laughing or crying among patients with certain neurological conditions or injuries. There is an outburst of crying or laughing that may not be connected to the current emotional state. Because pseudobulbar affect often involves crying, the condition is frequently mistaken for depression. We present the case report of a 54-year-old male patient who had a stroke and who presented to his physician with a chief complaint of crying spells. His family expressed, and his physician believed, that he was suffering from depression because of his dramatic clinical presentation. The patient initially denied that he was depressed. Despite the denial, he was managed with psychotherapy and an antidepressant medication, Remeron (mirtazapine). The treatment did not improve his clinical symptoms. He was eventually treated with dextromethorphan/quinidine (DM/Q), 20 mg/10 mg, with a dramatic resolution of the crying spells. However, psychosocial stressors, including the death of his father, job loss, and financial problems, made him depressed with vegetative symptoms. His crying spells came back and became more intense and frequent. He became worthless and hopeless. This depression was unrelated to his stroke. He was diagnosed with a major depressive disorder and was treated with antidepressants and psychotherapy. He experienced the depression several months after his crying spells resolved with the DM/Q. His recent bout of depression was treated with another antidepressant, vilazodone, and he was given a more intensive outpatient psychotherapy treatment. All the psychiatric symptoms, including the crying spells, have improved after treatment.

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Section: Discussionmentioning

confidence: 99%

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

Espiridion¹,

Risos

2018

Cureus

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“…The drug combination had a favorable safety profile, the most common adverse events being diarrhea and dizziness. 99,100 The administration of dextromethorphan /quinidine with antidepressants, serotonergic drugs and MAO inhibitors is contraindicated, because of the risk of dangerous interactions, in particular serotonergic syndrome.…”

Section: Managementmentioning

confidence: 99%

Emotions after stroke: A narrative update

Ferro

Santos

2019

International Journal of Stroke

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Aim In this narrative review we aimed to describe how stroke affects emotions and update the readers on the emotional disturbances that occur after stroke. Methods We searched Medline from 1.1.2013 to 1.7.2019, personal files and references of selected publications. All retrieved systematic reviews and randomized controlled trials were included. Other references were selected by relevance. Summary of review The emotional response includes a reactive behavior with arousal, somatic, motivational and motor components, and a distinctive cognitive and subjective affective experience. Emotional category responses and experiences after stroke can show dissociations between the behavioral response and the cognitive and affective experiences. Emotional disturbances that often occur after stroke include fear, anger, emotional indifference, lack of understanding of other emotions, and lack of control of emotional expression. Emotional disturbances limit social reintegration of the persons with stroke and are a source of caregiver burnout. The evidence to support the management of the majority of emotional disorders in stroke survivors is currently weak and of low or very low methodologic quality. An exception are the disorders of emotional expression control where antidepressants can have a strong beneficial effect, by reducing the number and duration of the uncontrollable episodes of crying or laughing. Conclusion Our current knowledge of the emotional disorders that occurs in acute stroke patients and in stroke survivors is heterogeneous and limited. Joint efforts of different research approaches, methodologies and disciplines will improve our current understanding on emotional disorder after stroke and indicate rational pathways to manage them.

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“…En Europa obtuvo autorización por la Agencia Europea de Medicamentos en 2013, pero fue retirado de mercado en 2016 por decisión de la empresa farmacéutica a cargo. El dextrometorfano actúa sobre los Alet, M.; Segamarchi, C.; Claverie, S.; González, L.; Lepera, S.; Rey, R. receptores sigma-1 y NMDA en el cerebro, y el sulfato de quinidina permite que el dextrometorfano alcance concentraciones terapéuticas (11). Hemos utilizado este tratamiento en el paciente con ACV crónico y SPB (sin depresión), con modestos beneficios a los seis meses de seguimiento.…”

Section: Placs Negativaunclassified

Síndrome pseudobulbar en pacientes con accidente cerebrovascular en Argentina

Alet

Segamarchi

Claverie

et al. 2019

Vertex Rev Arg Psiquiatr

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Introducción y objetivo: El síndrome pseudobulbar se define por episodios involuntarios o exagerados de risa o llanto, posteriores a una enfermedad específica. El síndrome pseudobulbar después del accidente cerebrovascular se reporta entre el 11%-34% de los pacientes. En nuestra población está subdiagnosticado. Determinamos su frecuencia en un grupo de pacientes post-ACV. Pacientes y métodos: Estudio observacional prospectivo desde junio/2017 a junio/2018. Se evaluaron dos poblaciones: ACV crónico (Grupo A) y ACV agudo (Grupo B). Se excluyeron pacientes con enfermedad psiquiátrica grave, deterioro cognitivo y/o afasia. Se realizaron las escalas PLACS (“pathological laughing and crying scale”) y CNS-LS (“Center for Neurologic Study-Lability Scale”). El síndromepseudobulbar se definió por criterios diagnósticos más ambas escalas positivas. Resultados: Cincuenta pacientes fueron evaluados. El 68% eran hombres. Edad media: 65±12 años. Grupo A: 19 casos y grupo B: 31 casos. PLACS positiva: 21% grupo A y 29% grupo B. CNS-LS positiva: 58% grupo A y 26% grupo B. Ambas escalas positivas en 8 pacientes (2 en crónico y 6 en agudo). Tres de ellos tenían depresión asociada. Conclusiones: El síndrome pseudobulbar debe examinarse cuidadosamente luego del ACV. La depresión post-ACV debe diferenciarse de la labilidad emocional por síndrome pseudobulbar. La administración de una sola escala no seríasuficiente para la orientación diagnóstica.

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Dextromethorphan/Quinidine for Pseudobulbar Affect Following Stroke: Safety and Effectiveness in the PRISM II Trial

Abstract: DM/Q effectively treated PBA and was associated with global and functional improvement; adverse events were consistent with the known safety profile of DM/Q.

Cited by 6 publications

References 33 publications

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

Emotions after stroke: A narrative update

Síndrome pseudobulbar en pacientes con accidente cerebrovascular en Argentina

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