Department of Neurology, Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
J Clin Psychopharmacol. 2009 Oct;29(5):444-52. doi: 10.1097/JCP.0b013e3181b5ae5c.
The purpose of this study was to characterize the brain activity and associated cortical structures involved in pseudobulbar affect (PBA), a condition characterized by uncontrollable episodes of laughing and/or crying in patients with multiple sclerosis before and after treatment with dextromethorphan/quinidine (DM/Q). Behavioral responses and event-related potentials (ERPs) in response to subjectively significant and neutral verbal stimuli were recorded from 2 groups: 6 multiple sclerosis patients with PBA before (PBA-preTx) and after (PBA-DM/Q) treatment with DM/Q and 6 healthy control (HC) subjects. Statistical nonparametric mapping comparisons of ERP source current density distributions between groups were conducted for subjectively significant and neutral stimuli separately before and after treatment with DM/Q. Treatment with DM/Q had a normalizing effect on the behavioral responses of PBA patients. Event-related potential waveform comparisons of PBA-preTx and PBA-DM/Q with HC, for both neutral and subjectively significant stimuli, revealed effects on early ERP components. Comparisons between PBA-preTx and HC, in response to subjectively significant stimuli, revealed both early and late effects. Source analysis comparisons between PBA-preTx and PBA-DM/Q indicated distinct activations in areas involved in emotional processing and high-level and associative visual processing in response to neutral stimuli and in areas involved in emotional, somatosensory, primary, and premotor processing in response to subjectively significant stimuli. In most cases, stimuli evoked higher current density in PBA-DM/Q compared with the other groups. In conclusion, differences in brain activity were observed before and after medication. Also, DM/Q administration resulted in normalization of behavioral and electrophysiological measures.
本研究旨在描述假性延髓情绪（PBA）的大脑活动及相关皮质结构，假性延髓情绪是一种在多发性硬化症患者中出现的无法控制的大笑和/或哭泣的状况，在使用右美沙芬/奎尼丁（DM/Q）治疗前后都有此状况。从 6 名 PBA 多发性硬化症患者（PBA 预治疗组）和 6 名健康对照者（HC）中记录了对主观显著和中性言语刺激的行为反应和事件相关电位（ERP）。分别对两组患者在治疗前后的主观显著和中性刺激进行 ERP 源电流密度分布的非参数统计映射比较。DM/Q 治疗对 PBA 患者的行为反应有正常化作用。对 PBA 预治疗组和 PBA-DM/Q 与 HC 的 ERP 波形进行比较，无论是中性还是主观显著刺激，都对早期 ERP 成分有影响。与 HC 相比，PBA 预治疗组在对主观显著刺激的反应中，既有早期效应也有晚期效应。与 PBA 预治疗组相比，PBA-DM/Q 组在对中性刺激的反应中，以及在对主观显著刺激的反应中，分别在涉及情绪处理和高级与联想视觉处理的区域以及涉及情绪、躯体感觉、初级和运动前处理的区域存在明显的激活。在大多数情况下，PBA-DM/Q 组比其他组的刺激引起更高的电流密度。总之，在药物治疗前后观察到大脑活动的差异。此外，DM/Q 的给药导致行为和电生理测量的正常化。
