Data from a study of PBA symptoms in veterans with mild traumatic brain injury presented

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Avanir Pharmaceuticals announced the presentation of results from a first-of-its-kind study of pseudobulbar affect (PBA) symptoms in veterans with mild traumatic brain injury conducted in collaboration with the Department of Veterans Affairs and Evidera. The study will be presented at the Tenth World Congress on Brain Injury in San Francisco, USA, on Friday 21 March 2014.

“It is estimated that between 12% and 23% of service members deployed to Iraq and/or Afghanistan have sustained a traumatic brain injury and this study suggests that many of these men and women may also be suffering from pseudobulbar affect, a distressing neurological condition marked by uncontrollable, disruptive episodes of crying or laughing,” says Regina McGlinchey, director of the Translational Research Centre for Traumatic Brain Injury and Stress Disorders, a Veterans Affairs Rehabilitation Research & Development Service, Traumatic Brain Injury Center of Excellence at Veterans Affairs Boston Healthcare System.

“More than half of responders from our study reported that they are experiencing symptoms of pseudobulbar affect. Those with pseudobulbar affect symptoms reported significantly worse health-related quality of life scores, and there appeared to be a high correlation between pseudobulbar affect symptoms and post-traumatic stress disorder.”

Highlights from the cross sectional survey results of 4,283 patients within the Veterans Affairs system include:

  • 758 (19%) veterans with traumatic brain injury responded to the survey an unusually high response rate for similar studies. 
  • 60% of respondents reported pseudobulbar affect symptoms, characterised by the presence of involuntary, uncontrollable episodes of crying and/or laughing that were exaggerated or even contrary to how they felt at the time.

In contrast, other commonly perceived challenges faced by veterans were reported less frequently, including: post-traumatic stress disorder (48%) major depression (31%) and anxiety disorders (18%).

Veterans who suffer from pseudobulbar affect symptoms were more likely to also suffer from post-traumatic stress disorder, a finding not previously understood or recognised. 

Among veterans with scores ≥13 in the Center for Neurologic Study-Lability Scale (CNS-LS), denoting pseudobulbar affect symptoms, 54% reported suffering from post-traumatic stress disorder versus approximately 32% of CNS-LS negative veterans.

In terms of measuring overall health status, those that suffered from pseudobulbar affect symptoms scored lower on the EQ-5D index (an international, standardised, general measure of health status) suggesting that they have an extra burden impacting their quality of life.

More than 94% of CNS-LS positive Veterans report at least some problems with pain/discomfort or anxiety/depression, the majority of whom had symptoms of at least moderate severity.

Veterans who suffer from pseudobulbar affect symptoms were also significantly more likely to be on antidepressants than those without pseudobulbar affect symptoms.

46% of CNS-LS positive veterans reported being on antidepressants versus approximately 31% of CNS-LS negative veterans

“Results from this benchmark study suggest a high prevalence of pseudobulbar affect symptoms among veterans with mild traumatic brain injuries, an issue that significantly compounds the burden on veterans as more troops reintegrate into society after active service,” says Joao Siffert, chief medical officer at Avanir. “Our ultimate goal with this research is to collaborate with the Veteran Affairs to develop a screening protocol for identifying pseudobulbar affect symptoms to help improve diagnosis, treatment and ultimately the quality of care for our nation’s veterans. Additionally, understanding the interplay between pseudobulbar affect and other brain injury neuropsychiatric consequences may help guide a more specific and comprehensive approach to patient care.”