Therapeutic use of dextromethorphan: Key learnings from treatment of pseudobulbar affect

Abstract A variety of neurological conditions and disease states are accompanied by pseudobulbar affect (PBA), an emotional disorder characterized by uncontrollable outbursts of laughing and crying. The causes of PBA are unclear but may involve lesions in neural circuits regulating the motor output...

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Bibliographic Details
Published in:Journal of the neurological sciences 2007-08, Vol.259 (1), p.67-73
Main Authors: Miller, Ariel, Panitch, Hillel
Format: Article
Language:English
Subjects:
Amyotrophic lateral sclerosis
Animals
Biological and medical sciences
Brain - drug effects
Chemical and industrial products toxicology. Toxic occupational diseases
Crying
Dextromethorphan - therapeutic use
Emotion
Enzyme Inhibitors - therapeutic use
Excitatory Amino Acid Antagonists - therapeutic use
Explosive
Humans
Immunomodulators
Laughing
Medical sciences
Multiple sclerosis
Multiple Sclerosis - drug therapy
Neurology
Neuroprotection
Pharmacology. Drug treatments
Pseudobulbar effect
Pseudobulbar Palsy - drug therapy
Pseudobulbar Palsy - etiology
Pseudobulbar Palsy - pathology
Quinidine - therapeutic use
Solvents
Toxicology
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Summary:Abstract A variety of neurological conditions and disease states are accompanied by pseudobulbar affect (PBA), an emotional disorder characterized by uncontrollable outbursts of laughing and crying. The causes of PBA are unclear but may involve lesions in neural circuits regulating the motor output of emotional expression. Several agents used in treating other psychiatric disorders have been applied in the treatment of PBA with some success but data are limited and these agents are associated with unpleasant side effects due to nonspecific activity in diffuse neural networks. Dextromethorphan (DM), a widely used cough suppressant, acts at receptors in the brainstem and cerebellum, brain regions implicated in the regulation of emotional output. The combination of DM and quinidine (Q), an enzyme inhibitor that blocks DM metabolism, has recently been tested in phase III clinical trials in patients with multiple sclerosis and amyotrophic lateral sclerosis and was both safe and effective in palliating PBA symptoms. In addition, clinical studies pertaining to the safety and efficacy of DM/Q in a variety of neurological disease states are ongoing.
ISSN:0022-510X
1878-5883
DOI:10.1016/j.jns.2006.06.030