Has Anyone Gone Berserk?

I'm not sure we have covered this topic lately, but since I recently went through it, I thought it might be time.  MS affects more than sensory nerves, muscles, internal organs and such.  It is very much a gray matter disease also.  It can affect our thinking (or lack thereof) our percerptions, our emotions, our attention spans, and our control over our responses.

One of the things that people with MS frequently complain about is sudden and inappropriate anger at relatively minor situations.  A situation that might otherwise urk us can suddenly become a massive breaking point in which we abruptly begin yelling or arguing or acting out of character.  Yesterday my sister did something that I have been annoyed about for a long time.  Instead of discussing my hurt feelings with her, like I have before, I went berserk, and then both of us were crying.  Where in the heck did that come from?  My response was all out of proportion to the event.

The converse can also happen.  A serious situation can evoke gales of inappropriate laughter that we can't control.  This response can be very embarassing.  

Inappropriate and exagerated emotions are actually frequent in MS.  It is called the Pseudobulbar Effect and was described decades ago.  It can even be a clue that someone has MS.

One of our earliest members had an episode where she suddenly became unable to walk.  She was in the ER and they were trying to see whether or not she could even bare weight on her legs.  She was laughing hysterically.  After assuring that she wasn't high, the doctor pulled her husband aside and told him that he was suspicious of her having MS - which she was eventually diagnosed with. (Good pick up!).

This is something that our family and friends should probably know about.  One so that we don't alienate everyone around us, and two, so that they don't haul us away.  We also should know about it, so we don't start considering basket-weaving class.  Having just had such an epsiode, it makes you truly question your sanity.  It's good to know that there is a well-known and physiologic  basis for it.

Jus' thinking

Quix

[Guitar_grrrl]

I honestly believe I've had this stupid disease since I was a teen, because I would laugh or cry at the most inappropriate moments.  One afternoon, I laughed for 45 minutes straight.  Crazy!  I also smiled at bad news, and then would suddenly turn away or leave the room because I was so ashamed of how I reacted to the news.  This went on and off for 3 years.  

Not so much a problem these days, other than a week or so of rage just before my menstrual cycle - much more than usual.  Luckily (?), I'm going through menopause, and haven't had a cycle for 7 months, and have had only one cycle for the year.  Coincidence?  Probably...

[Sumanadevii]

I think pain can bring someone to that state but just MS?  Naw.  We are all the same.  Some pretend to be all level with emotions and what happens behind closed doors is another whole story.  

One thing I dislike about people that pretend to be so sweet is the swords they throw in their words.  Of course, they are never angry or jealous or any emotions.  Some how they are just "little sweeties".  Trust me those little sweeties with flowering words ain't that....karma kicks hard when it comes time to pay.

I also think it is healthy to display all emotions.  Happy, sad, angry, jealous, joyous, etc.  If you are...who are you hiding it from...lol..If ya believe in God surely he knows.  If you believe in karma then you yourself know!!

[maxthecat9196]

I've been doing that kind of thing too.  

[Deb61]

I have been on steroids for the five days and thought I was home free.  After weighing in at the last Weight Watcher meeting, I started to cry over not losing weight!  I was so embarrased during the meeting that I wanted to leave, but knew it completely embarrass me. For one, my foot was numb and I would stumble out, and the other the people in the back would see me walking out when everyone in the room was obviously happy with a light-hearted meeting and their "bravo" stickers.  LOL

To make matters worse when I went home, I got really testy with my husband and ended up in a huge outburst over absolutely nothing.  I cannot even remember what it was that I blew up about (memory issues).  

I do feel better on the steroids, but will be glad when I'm done Tuesday.  I'm not so great handling my emotions even when off of them . . .

I guess the only thing one is to do is to warn our family of this possibility.  I have apologized to my husband, and he's such a good guy that he asked me what I was even talking about.  He says that he can't remember . . . (how could he forget, though?).  

[Quixotic1]

Yes, MS can and does cause that kind of inappropriate emotion by virtue of the kind of damage it causes in our brain.  It also occurs in other brain diseases and damage.  You only have to look at the common MS literature to see this.   Can it happen to anyone?  Yes.   The point is that it occurs much more often in altered brain function.

http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/symptoms/emotional-changes/index.aspx

http://www.ncbi.nlm.nih.gov/pubmed/16674978

http://ms.about.com/od/signssymptoms/a/cmp_ieed.htm

http://en.wikipedia.org/wiki/Pseudobulbar_affect

http://www.pbainfo.org/

http://www.msrc.co.uk/index.cfm/fuseaction/show/pageid/1273

Here are a smattering of the many articles discussing this.  I got tired of cutting and pasting or I could have shown a couple dozen more.

Quix

[Quixotic1]

OOOOoops!  Bob brought it to my attention that the term is actually

Pseudobulbar Affect.

Sorry, guys.  I read it at least 10 times - wrong each time.

Quix  :))

[Sumanadevii]

Quix, the above was my opinion and nothing more.  I stand by it even with the health pages.  If someone has anger it is just an emotion.  It is what is done with it is important.  So you had a fit, cried, it's over but If you are so angry you are gonna kill someone, I think the neuro needs to know.  But, in my opinion, I wouldn't blame it on MS.

My thinking is if MS can bring us to anger due to brain damage, then why not to more loving.  Love is just an emotion, too.

JMO

[supermum_ms]

hmmm true to form I am known for laughing my head off when the situation is seriously not funny. Once coming back from holiday overseas (i immigrated to OZ as a child) my replacement pass port had a fault in the stamp (error by immigration not me lol). I was sternly told i could be deported to England, which is my country of birth and i promptly burst into a fit of giggles, which only made the officer even more stren. Me though was still struggling to keep my self seated, yep rolling on the floor laughing was close. The more serious it got, the more funny it all apeared to be, hubby was terrified lol

My mother having a bipolar fit when the hospital screwed up my LP appointment, i laughted for hours that day, couldn't help it, lol the more i giggled the more angry she got that they where doing this to me lol she only calmed down after i wispered to her to please stop because its not a good idea to p/o the dr who is about to stick a great big needle in my spine, the look on her face set me off again. True story and the nursing staff had fun joking with me all day too, laughing is contagous and so is anger.

Thats not to say i dont display anger but to loose it, to really loose control of that emotion, for me is rare. I have faced dangerous situations, where that control has defused the dangerous and irrational aggression, i'm greatful that i have this as part of my character, it never lets me or anyone down. To be honest i sort of feel insulted that being in control of your self, could be seen as a falsehood, especially when thats a huge part of who I am, no reason to fake it, it just is, me!

On the other hand, laughing until my gut hurts, tears are flowing and the only sound coming out of me is more in line with a pig, well thats another story, but i wouldn't trade that either because it sure feels good to laugh!! I really can't say the same about anger, it leaves me always feeling ashamed and guilty for inflicting the hurt on someone else, its a sad thing to be apart of, even if it feels warented at the time, it still does no one any good.

During my last relapse i could feel the anger building and building, pmt on steroids, i didn't even trust my self to keep in control on the forum. I sure hope that isn't a sign of things to come, i literally wont know who I am anymore. [Sigh] If it is, I think that maybe one of the hardest for me to accept, do we not, forgive our selves and accept too much already?

Sorry Quix you had to deal with this too!!

Cheers.........JJ

[Sarahsmom46]

I have berzerk moments too, thankfully not very often.

The other day my PT was taking me outside for wheelchair training.  We were on the sidewalk about to cross over a driveway when this taxi started honking and sped up to the road an cut us of almost hitting someone else trying to cross.  He got stopped at the road and couldn't full out so while we were passing behind his car without any warning, I reached out and hit his car several times with my fist.  I was embarrassed  abut what I did and told my PT to pretend she didn't see that.  Oy!  Blame it on the MS.

Julie

[kerrtelli]

I have been laughing at very innapropriatenthings since I was a teenager.
I should have known.

Steroids made me a very nasty girl yesterday.  Had to apologize to my husband after biting his head off.

Luckily he's a nice guy and understood and was just happy that o as finally going to sleep.

[emmyvera]

Thanks for posting this Quixotic1!!! Wow!

I've not been dx yet, but I had my MRI Wednesday for MS. Waiting on results.

Why I am very interested in this topic, is because I have those exact same whack-out moments! I've never thought that this is something to add in my journal, but I now will do that.

For the last few years, I've just freaked out over nothing. My husband says the "wrong" thing or I can't figure out how to get a recipe right in the kitchen - I just start yelling and a lot of times throw things.

My husband is the sweetest man ever and we rarely argue, unless I do one of these freak outs. I do it over nothing and get very emotional and yell. It lasts about 10 minutes or so and I have to be alone to make it better. Then afterwards I feel as if a monster was let out and I feel guilty and then cry.

I never acted this way through my childhood or in college. I rarely got upset over anything and never yelling or angry like this.

I talked to my GP about this years ago and he lowered my birth control dosage because we couldn't figure out why I was acting this way. Since it has been a problem (used to be about once a week) (now about once every couple of months) I watch myself and try to change my responses as soon as I notice I'm getting angry. It has worked some, BUT now I'm interested to know if this ties in with all of my other symptoms. Yikes!

I too also laugh when I shouldn't. I'll catch myself starting to giggle then try to make myself stop because I know it is not right.

Thanks again! Very interesting!

[twopack]

Of course not EVERY outburst of emotion is Pseudobulbar Affect.  That would be as inaccurate as assuming every pain or tingling or incontinence is 'our' MS.  Over time we learn to know our self that has MS and can determine what things need meds and what things require more self-control.

I do think we have to remember that MS is the disease we live with not an excuse we keep handy.

I also know that Pseudobulbar Affect is very real.  I wonder if a person who has mainly spinal lesions can fully appreciate what it is like to have a brain riddled with lesions as well?  Frankly, the statement that pain can bring a person to raw emotion but "just MS" can’t sounds insensitive and hurtful to me.  It is the kind of thing we come to expect from healthy people who can't possibly understand what it is like to have MS.  It is a kick in the arse from a fellow prisoner of the disease.

As always, private opinions are allowed but it always seems easier to dismiss proven medical facts when the opinion generator isn't the one experiencing the specific body process betrayal in question.  Isn't that the type of thing that makes us so angry with doctors?  That they dismiss our REAL complaints as FICTION?

That's my opinion.
BTW DQ, I hope you and your sister worked it out and are better prepared now in case there's a next time.

Mary

[poorkid]

It has been awhile since I have been here so I may not be correct, but Quix, I think I read that you started Tysabri..

It seems that since I have been on Tysabri that I have found my moods swing to the extreme frequently. Not saying that MS doesn't (and has in the past) caused the same issues but the Tysabri really seems to intensify those little outbursts!  

Just a thought...

[opie74]

Did you see my post last week?  I have a script for something to help with it, but I just can't bring myself to take psych meds.  i had had a rough morning and the tinest little thing sent me into a rage/crying spell.  When it was over, I hardly remember what I said to anyone.  So completely and totally NOT ME!  

[Quixotic1]

Sumana - I understand that you do not believe that what I wrote is grounded in science and not my opinion, but I want you and everyone to understand that what I wrote is NOT from a Health Page.  The cites I gave were from a combination of articles, scientific studies and info from major MS associations.  However, one is free to believe that the earth is flat based on their own opinion, if that is how they want to form their beliefs.

If this happened to me on any kind of regular basis, I certainly would inform my doctors.

Opie - I would encourage you to view your script as a "brain" med needed for a "brain disease".  The kind of outbursts you are describing are not normal, they disrupt your life and that of your family and are suggestive of depression - another very common product of MS.  Please try the meds and give them enough weeks to take effect.

Mary - We had worked it out within an hour.  She told me that she was aware of the problem im MS and tried to view it that way once she was over the initial assault.  This has happened to me about three other times in the last 7 or 8 years.  She saw one of them and we had a long talk about it.  It always happens in the evening when I am too tired.  I am normally pretty even-keeled.  I learned to keep my emotions in check when I practiced medicine, so I am as blindsided as my sister when something like this happens.

With regard to exerting more control, that might be hard.  Scientists believe that Pseudobulbar Palsy (one of its other names) is from damage to the area that allows us to control our emotions.  Thus, the very area that we might need is already damaged.

Emmy - you might go ahead and read those articles to better understand this.

Poorkid - thanks for the heads up.  This is the first instance since I started in June and actually since early 2009, but I will keep watch.  

Quix

[twopack]

So glad to hear you and your sister had it worked out pretty quickly Quix.

As for the self-control part, I didn't mean to refer to that as being possible when pseudobulbar affect is causing a person to have out-of-character outbursts of anger or laughter.

I was afraid I was seeing the beginning of a trend where people might end up using the information to explain away years of ordinary (and controllable) bad behavior.

I must admit that I'd be a little hesitant to share this info with some people I interact with.  Can anyone else think of a person or two they don’t want to hand any call-me-crazy ammunition?

Mary

[RazCarver]

I tend to laugh at the wrong times. Like my 1st neurologist appointment, when I couldn't walk heel to toe, touch my nose or stand with my feet together. I got the giggles as I found it highly amusing that stone cold sober I couldn't pass a street drunk test.

Bad timeing because my neurologists put down he is also seeing me for anxiety and MS. However I'm still in limbo.

But I think it is just the way I respond to things. Has been known to get me into trouble. To think that disease could cause this to happen more is a frightening thought.

Really some things are funny. OK it shouldn't be laughed at maybe but still....to come home and find my partner in a power chair in the bathroom with the sink in her lap. Couldn't help the chuckles. I tried but it was funny. Told her to turn the power to low when going in the bathroom...but no. So she bumped the pedestal and lifted the sink off the wall hooks.

That was when I was in my late 30's. Granted I tend to get tickled over the dumbest things now and more often laugh till I cry and can't stop it. I don't know. Wish I had internet on my computer so I could follow all your links. Working on that.

Thanks for the info
Raz

[opie74]

I was directly told it was Pseudobulbar and was given a script for Nudexta.  It was 4.5 weeks before it happend again.  I am on enough junk.  I am beginning to think that I am taking meds to counteract the effects of other meds.  Maybe I should get off of everything but the Gilenya an the proton pump inhibitor....  can't do that, I know, but  I don't want to just keep throwing meds at problems.  I figure, right now, it happens so infrequently that I will just wait to medicate it.  If it were once a week or so, then I might really worry.

It is good to know that I am not the only one out there though.

[jensequitur]

I can say definitely that not every over-the-top emotional reaction is from pseudobulbar effect.  I have flown off the handle more times than I can count this past year alone.  Granted, it's not like I didn't have provocation, but previously I would have dealt with it in a different way.  These days I just get so mad I can't see straight.  I'm going to have to find another way to deal, I guess.

However, the first time I woke up and discovered my toe was sticking straight up and would not go back down, I started laughing.  Was that pseudobulbar effect?  Or was I just laughing because it was so wrong and weird?  

[Karen99]

Quix - your posts are insightful and thought provoking.  While I haven't gone berserk (yet), I recognize that my perception of situations may be exaggerated.  The links you provided were helpful.  Thank you.

      

  

[tingletingle]

Thanks for the insight. I must confess that my family do think I get alot crankier since being diagnosed. I put it down to trying to come to terms with the whole MS thing. Certainly, the difficulty with walking every 4 or 5 days is starting to wear thin.

So thank you for sharing, at least now I know 'I'm normal' with this and the other myriad of sxs.

Blessings
Alex

[essdipity]

It seems to me that the original point of this post is getting lost. Lots of us are more irritable than before. Just living with MS can do that, And maybe we're short-tempered for other reasons entirely. Life is not all MS. :-)

It's my understanding that the pseudobulbar affect is far more obvious than that. Do you remember James Brady, Reagan's press officer who was shot in the head during the attempted assassination? The area of his brain controlling expression of emotions was severely damaged, and he would laugh, cry, get angry, whatever, in a way that's really inappropriate in our society. That's an extreme example of this affect, of course, but it demonstrates what direct brain damage can do.

Just wanted to put this in perspective.

ess

[rendean]

I have recently been prescribed Nudexta as off-label use for pain then he discussed if there was a legit use in the form of pseudobulbar  affect, and my DH started laughing and said "Boy there sure is...need someone to cry for you? Fly off the handle? We've got it"

I have begun taking it and it does cut down on these emotional outburst as well as helping with the pain issue.

So, for those of you who suffer, ask your neuro about Nudexta.

Ren