Pseudobulbar syndrome (paralysis): causes, symptoms, treatment

Gavrilkina Oksana Sergeevna Chief rehabilitation doctor, physical therapy and sports medicine doctor,

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Pseudobulbar syndrome (supranuclear bulbar palsy) is a disease associated with impaired blood supply to the cranial nerves of the medulla oblongata. The pathology is more common in older people as a result of atherosclerosis of the cerebral arteries. Unlike bulbar syndrome, pseudobulbar syndrome is not life-threatening, but reduces its quality and duration.

Causes of development of pseudobulbar palsy

The cause of the disease is considered to be chronic cerebrovascular accident. As a result, control of the IX (glossopharyngeal), X (vagus), XII (hypoglossal) pairs of cranial nerves from the cortical structures of the brain is blocked. In this way, pseudobulbar syndrome differs from bulbar syndrome, in which the tissue of the nuclei of these nerves is affected.

The most common cause of illness in the elderly is cerebral atherosclerosis , which leads to disruption of the trophism of the nervous tissue of the medulla oblongata.

Other causes of pseudobulbar syndrome:

severe course of hypertension ;
Parkinson's disease;
consequences of strokes ;
encephalitis and other inflammatory diseases of the central nervous system;
traumatic brain injuries;
brain tumors.

The disease leads to motor disorders of the muscles of the face, pharynx and articular apparatus involved in speech production. Hemiparesis and monoparesis develop less frequently.

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Symptoms

The clinical picture is characterized by the triad of pseudobulbar palsy: dysarthria, dysphonia, dysphagia . Dysarthria is associated with impaired speech articulation, the ability to clearly and articulately pronounce words and sounds. Dysphonia refers to the sonority of the voice, which becomes quieter or disappears completely. Dysphagia is associated with impaired swallowing and choking when eating food.

The following signs indicate the appearance of pseudobulbar syndrome:

uncontrolled contraction of facial muscles, not associated with emotions;
causeless laughter, less often crying;
drooping of the lower jaw, as a result of which the mouth is constantly open, and saliva accumulates in the corners of the mouth;
quiet slurred speech, jumbled consonants and mixed vowels, making it difficult to communicate with others;
rapid fatigue when communicating, isolation and stiffness;
difficulty eating due to the inability to swallow liquid and mushy food;
deterioration of memory, attention, ability to perceive new information, decrease in volitional qualities;
motor disorders in the limbs.

In contrast to bulbar syndrome, with pseudobulbar disorders, central paralysis develops, the muscles of the tongue, palate and pharynx do not atrophy (only the innervation is impaired), normal reflexes are preserved and pathological reflexes of oral automatism, characteristic of infants, appear.

What is bulbar dysarthria

Bulbar dysarthria is a person’s loss of articulate expressive speech caused by a disorder of the articulation apparatus by damage to the cranial nerves (IX, X, XII pairs). The clinical picture of this disorder is as follows:

slurred speech;
slow pace (braking);
monotone;
paucity of speech;
dysphonia;
the swallowing reflex is impaired.

The bulbar type of dysarthria can be established after speech therapy and neurological examination. To identify it, a number of examinations must be carried out - MRI, CT, cerebrospinal fluid analysis and others. The clinical picture of bulbar dysarthria depends on the lesion.

Diagnosis of the disease

An examination for pseudobulbar syndrome is aimed at identifying signs of atherosclerosis, foci of ischemia (blood supply disorders) and neoplasms in the brain. Laboratory diagnostic methods include general clinical and biochemical blood tests and a lipid profile. Instrumental research methods include angiography of cerebral vessels, CT (computed tomography) or MRI (magnetic resonance imaging).

When clinical signs associated with bulbar disorders are identified, a differential diagnosis of pseudobulbar and bulbar palsy is carried out.

How to influence the condition in newly born children

If pseudobulbar syndrome has been diagnosed in newborns, treatment will involve an integrated approach. First of all, this is a massage of the orbicularis oris muscle, feeding through a tube and electrophoresis with proserin on the cervical spine.

Speaking about the first signs of recovery, it is worth noting that they include the appearance of reflexes of the newborn, which were previously absent, stabilization of the neurological status and positive changes in the deviations recorded earlier. Also, with successful treatment, there should be an increase in motor activity against the background of physical inactivity or an increase in muscle tone in the case of severe hypotension. In children with long gestational ages, a meaningful reaction to contact and emotional tone improves.

Treatment

Therapy is aimed at improving blood supply to the brain and slowing down the destruction of nerve cells. Unfortunately, pseudobulbar syndrome is incurable, but it is possible to improve the quality and increase the life expectancy of the patient. Treatment must begin at the first signs of the disease before irreversible changes in the central nervous system have occurred.

For pseudobulbar syndrome, conservative and surgical methods are prescribed. Therapy should be aimed at the cause of the syndrome. For atherosclerosis and ischemia, medications are recommended; for a brain tumor, surgery is performed to remove the tumor.

Conservative treatment includes:

statins to normalize cholesterol metabolism and prevent the formation of atherosclerotic plaques in the vessels of the brain;
nootropics to improve the trophism of nervous tissue;
antihypertensive drugs to regulate blood pressure and prevent strokes;
vascular agents that improve the flow and flow of blood into the brain;
massage of the cervical-collar area, physiotherapy, therapeutic exercises.

With timely treatment, the development of symptoms of pseudobulbar palsy slows down and health improves. The patient should be under regular supervision of a neurologist to diagnose disease progression and adjust therapy.

Epidemiology[edit]

Prevalence estimates place the number of people with LBA at 1.5 to 2 million in the United States alone, representing less than 1% of the US population even at the high end of the estimate. Some argue that the number is likely higher and that doctors underestimate PBA. [49] However, the prevalence estimate of 2 million is based on an online survey. Self-selected computer-savvy at-risk patients rated their own symptoms and provided their diagnosis. Neither the doctor nor the clinic confirmed these data. Motivation to participate may have been influenced by the presence of symptoms, which would have confounded the results. The actual prevalence may well be slightly lower than estimated. [50]