Involuntary Emotional Expression Disorder
One of the lesser-known symptoms of MS is involuntary emotional expression disorder (IEED). This condition has been previously called pseudobulbar affect, emotional lability, emotional incontinence, and pathological laughing and crying. To avoid confusion, medical professionals are now using IEED as an "umbrella term," to replace all of the other references used previously.
IEED is a neurologic condition characterized by uncontrolled or exaggerated episodes of crying, laughing, or other emotional display, occurring with only minimal or no stimulation to invoke such a response. People who suffer from this condition have some type of neurologic disorder, typically MS, amyotrophic lateral sclerosis (ALS), Parkinson's disease, dementias (including Alzheimer's disease), or a neurologic injury (including stroke and traumatic brain injury). At least 10 percent of MS patients are believed to experience IEED.
An estimated 1.5 million people in the United States are thought to have IEED, although the actual number might be much greater. Not all physicians are familiar with this disorder, and patients with IEED are frequently misdiagnosed with depression, bipolar disorder, generalized anxiety disorder, personality disorder, and sometimes even epilepsy. One difference is that these other disorders have sustained emotional states over long periods of time, while IEED's emotional episodes are relatively short in duration. Two standard rating scales (PLACS and CNS-LS) are available for physicians to screen and evaluate patients for IEED, as well as to monitor their response to treatment.
The cause of IEED and the process by which it occurs are not fully understood. Chemical changes (neurotransmitters) and increased electrical activity in cells related to emotional responses are being investigated for potential involvement with this disorder.
The symptoms of IEED can be severe, with persistent episodes of emotional outbursts. Individuals who suffer from this disorder may become depressed, often experiencing anxiety and embarrassment over crying and laughing at inappropriate times in social situations. This disrupts one's social and professional life, affecting families and care partners as well.
At this time, no drug has been FDA approved to treat IEED. When diagnosed, most MS experts prescribe off-label use of anti-depressants. Anti-psychotic or anti-epileptic drugs are less frequently prescribed alternatives. New agents to treat IEED are presently under development.
A new drug from Avanir Pharmaceuticals, known as Neurodex™, has been submitted for FDA approval in treating IEED. According to Avanir, two multi-center Phase III clinical trials found that MS patients and ALS patients treated with Neurodex achieved a statistically significant reduction in the frequency and severity of IEED episodes, as measured by the CNS-LS (scale). The FDA is expected to complete its review of the study data by the end of October 2006.
Information for this article was found on Avanir's website at www.avanir.com. To learn more about IEED and Neurodex, readers may call Avanir toll free at (888) 805-8852 or visit www.ieed.org. Readers may also contact MSAA's toll-free Helpline at (800) 532-7667 for additional support and information.
By Susan Wells Courtney
Reviewed by Dr. Jack Burks
