Low-dose quinidine in combination with dextromethorphan reduces the frequency of uncontrollable laughing or crying in multiple sclerosis

This report is part of a 12-month Clinical Context series.

By Richard Robinson, Contributing Writer, MedPage Today
Published: June 04, 2010
Reviewed by Ari Green, MD; Assistant Professor, University of California, San Francisco.


SAN ANTONIO -- Low-dose quinidine in combination with dextromethorphan reduces the frequency of uncontrollable laughing or crying in multiple sclerosis while improving patient safety, according to research presented here.


Using just a third of the quinidine dose contained in the current combination therapy, marketed as Zenvia, reduced those episodes by more than half, compared with a decrease of about one a day with placebo (P=0.0280), Daniel Wynn, MD, of Consultants in Neurology in Northbrook, Ill., and colleagues found.


Pseudobulbar affect (PBA), characterized by laughing or crying outbursts incongruent with the patient's emotional state, affects 15% of patients with MS, and is also seen in ALS, Alzheimer's disease, and other neurologic diseases.


"Pseudobulbar affect causes considerable distress for patients and caregivers," Wynn told attendees at the meeting of the Joint Consortium of Multiple Sclerosis Centers and America's Committee on Treatment and Research in Multiple Sclerosis. "It can be extremely socially disabling, and it is often under-recognized and undertreated."

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