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Impaired corticopontocerebellar tracts underlie pseudobulbar affect in motor neuron disorders.
Neurology. 2014 Aug 12; 83(7):620-7.Neur

Abstract

OBJECTIVE

The objectives of the study were (1) to determine the prevalence and characteristics of pseudobulbar affect (PBA) in patients with primary lateral sclerosis (PLS) and amyotrophic lateral sclerosis (ALS) in an outpatient clinic population, and (2) to test the hypothesis that damage of inputs to the cerebellum, leading to cerebellar dysmodulation, is associated with PBA.

METHODS

Chart review of all patients with PLS and ALS seen between 2000 and 2013. The examining neurologist documented the presence or absence of PBA in 87 patients. Forty-seven patients also had diffusion tensor imaging (DTI) studies. Tract-based spatial statistics were used to compare DTI of patients with and without PBA to identify altered white matter tracts associated with PBA.

RESULTS

Thirty-one of 50 patients with PLS and 12 of 37 patients with ALS had PBA. Psychiatric/emotional assessment found congruence between mood and affect during episodes, but excessive magnitude of the response. DTI studies of 25 PLS and 22 ALS patient brains showed reduced fractional anisotropy of the corticospinal and callosal white matter tracts in all patients. Patients with PBA additionally had increased mean diffusivity of white matter tracts underlying the frontotemporal cortex, the transverse pontine fibers, and the middle cerebellar peduncle.

CONCLUSIONS

PBA is common in PLS. Imaging findings showing disruption of corticopontocerebellar pathways support the hypothesis that PBA can be viewed as a "dysmetria" of emotional expression resulting from cerebellar dysmodulation.

Authors+Show Affiliations

From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY. floeterm@ninds.nih.gov.From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY.From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY.From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY.From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY.From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY.From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY.From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY.From the National Institute of Neurological Disorders and Stroke (M.K.F., R.K., M.P.K., O.S., M.S., L.D., T.W., A.M.), NIH, Bethesda, MD; and Departments of Psychiatry and Neurology (E.D.H.), Columbia University, New York, NY.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

25008395

Citation

Floeter, Mary Kay, et al. "Impaired Corticopontocerebellar Tracts Underlie Pseudobulbar Affect in Motor Neuron Disorders." Neurology, vol. 83, no. 7, 2014, pp. 620-7.
Floeter MK, Katipally R, Kim MP, et al. Impaired corticopontocerebellar tracts underlie pseudobulbar affect in motor neuron disorders. Neurology. 2014;83(7):620-7.
Floeter, M. K., Katipally, R., Kim, M. P., Schanz, O., Stephen, M., Danielian, L., Wu, T., Huey, E. D., & Meoded, A. (2014). Impaired corticopontocerebellar tracts underlie pseudobulbar affect in motor neuron disorders. Neurology, 83(7), 620-7. https://doi.org/10.1212/WNL.0000000000000693
Floeter MK, et al. Impaired Corticopontocerebellar Tracts Underlie Pseudobulbar Affect in Motor Neuron Disorders. Neurology. 2014 Aug 12;83(7):620-7. PubMed PMID: 25008395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impaired corticopontocerebellar tracts underlie pseudobulbar affect in motor neuron disorders. AU - Floeter,Mary Kay, AU - Katipally,Rohan, AU - Kim,Meredith P, AU - Schanz,Olivia, AU - Stephen,Matthew, AU - Danielian,Laura, AU - Wu,Tianxia, AU - Huey,Edward D, AU - Meoded,Avner, Y1 - 2014/07/09/ PY - 2014/7/11/entrez PY - 2014/7/11/pubmed PY - 2014/10/8/medline SP - 620 EP - 7 JF - Neurology JO - Neurology VL - 83 IS - 7 N2 - OBJECTIVE: The objectives of the study were (1) to determine the prevalence and characteristics of pseudobulbar affect (PBA) in patients with primary lateral sclerosis (PLS) and amyotrophic lateral sclerosis (ALS) in an outpatient clinic population, and (2) to test the hypothesis that damage of inputs to the cerebellum, leading to cerebellar dysmodulation, is associated with PBA. METHODS: Chart review of all patients with PLS and ALS seen between 2000 and 2013. The examining neurologist documented the presence or absence of PBA in 87 patients. Forty-seven patients also had diffusion tensor imaging (DTI) studies. Tract-based spatial statistics were used to compare DTI of patients with and without PBA to identify altered white matter tracts associated with PBA. RESULTS: Thirty-one of 50 patients with PLS and 12 of 37 patients with ALS had PBA. Psychiatric/emotional assessment found congruence between mood and affect during episodes, but excessive magnitude of the response. DTI studies of 25 PLS and 22 ALS patient brains showed reduced fractional anisotropy of the corticospinal and callosal white matter tracts in all patients. Patients with PBA additionally had increased mean diffusivity of white matter tracts underlying the frontotemporal cortex, the transverse pontine fibers, and the middle cerebellar peduncle. CONCLUSIONS: PBA is common in PLS. Imaging findings showing disruption of corticopontocerebellar pathways support the hypothesis that PBA can be viewed as a "dysmetria" of emotional expression resulting from cerebellar dysmodulation. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/25008395/Impaired_corticopontocerebellar_tracts_underlie_pseudobulbar_affect_in_motor_neuron_disorders_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=25008395 DB - PRIME DP - Unbound Medicine ER -