What’s the Difference Between Pseudobulbar and Bulbar Palsy?

The term "bulbar palsy" describes the paralysis of specific facial muscles. Although pseudobulbar palsy shares some symptoms with bulbar palsy, it is not the same condition and requires a distinct kind of care.

Doctors refer to a broad phrase used to indicate paralysis of the muscles of your mouth and face called the bulbar muscles, as "bulbar palsy." Your ability to swallow, speak, and move your face may all be affected by this.

A unique constellation of symptoms is associated with pseudobulbar palsy. Because it had some symptoms with bulbar palsy, scientists came up with the phrase in 1877Trusted Source to differentiate the two conditions. "Pseudo" refers to "fake." Given that the two are caused by distinct brain regions that are impacted, the name might not be entirely appropriate.

Learn more about the differences between these two terms by reading on.

How do symptoms differ between pseudobulbar and bulbar palsy?

While both adults and children may be affected by motor neuron disease, which can result in bulbar or pseudobulbar palsy, symptoms typically appear after age 50.

Some of the symptoms of bulbar palsy and pseudobulbar palsy are similar.
  • difficulty swallowing (dysphagia)
  • slowed, slurred speech (dysarthria)
  • vocal cord muscle spasms that change your voice (dysphonia)
Involuntary emotional expression disease, another name for pseudobulbar palsy, also presents with some of the following symptoms:
  • exaggerated facial expressions
  • Pseudobulbar affect, or uncontrollably sobbing or laughing when you're not feeling joyful or sad
  • difficulty chewing
  • emotional lability, where you feel extreme emotions
Bulbar palsy symptoms can include:
  • weakness in your tongue
  • involuntary jerking of your jaw muscles
  • lack of a gag reflex
Bulbar palsy can either be non-progressive, meaning that symptoms do not worsen with time or progressive, where symptoms do.

Progressive bulbar palsy

Although bulbar palsy is a symptom, the condition known as "progressive bulbar palsy" may also be mentioned.

A type of motor neuron illness called progressive bulbar palsy is comparable to Lou Gehrig's disease, also known as amyotrophic lateral sclerosis (ALS). Bulbar onset occurs in about 25% of ALS cases. Most instances start in the limbs, usually in the arms or legs.

Progressive bulbar palsy in kids and teens can cause Fazio Londe syndrome, an uncommon but treatable disorder with extra symptoms including breathing problems and hearing loss.

What causes pseudobulbar and bulbar palsy?

Degeneration of some of the cranial nerves that carry information from your cerebral cortex (the outer layer of your brain) to your lower brain stem causes pseudobulbar palsy and bulbar palsy.

Your capacity to regulate the movement of your face and mouth muscles is impacted by this damage to your nerves.

Pseudobulbar palsy is brought on by injury to the top motor neurons in the brain and spinal cord.

Bulbar palsy, on the other hand, is brought on by injury to the lower motor neurons in your peripheral motor nerves.

Who is at risk for pseudobulbar and bulbar palsy?

Pseudobulbar palsy can result from a few conditions, which include:
  • stroke
  • traumatic brain injury
  • ALS
  • Alzheimer’s disease
  • Parkinson’s disease
  • multiple sclerosis (MS)
The following conditions can result in bulbar palsy:
  • brain stem stroke
  • myasthenia gravis
  • diphtheria
  • Guillain-Barré syndrome

How do doctors diagnose pseudobulbar and bulbar palsy?

A medical professional will examine you physically and inquire about your medical history to identify pseudobulbar or bulbar palsy. The doctor will examine you and check the following:
  • ability to control your facial muscles
  • speech
  • emotional expressiveness
Depending on the findings of your physical examination, a physician might advise any of the following procedures:
  • electroencephalogram (EEG) to find any issues with brain cell communication
  • MRI or CT scan of your brain
  • A whole blood count that includes a serologic test to detect the presence of antibodies in your blood
  • examination of cerebral spinal fluid (CSF) obtained through a spinal tap
Tell a doctor if you experience uncontrollably high or low moods and you believe you may have pseudobulbar palsy. Misdiagnosing PBA as some of the following conditions occurs frequently:
  • depression
  • bipolar disorder
  • generalized anxiety disorder

How does treatment differ between pseudobulbar and bulbar palsy?

Although there is no known treatment for bulbar or pseudobulbar palsy, these symptoms can be controlled.

Physical and speech therapy are examples of rehabilitation therapy that can help you live a better quality of life and assist you in performing daily tasks.

Bulbar palsy can be managed by a physician in the following ways:
  • give anticholinergic medications to aid in stopping droolings, such as oxybutynin (Ditropan XL) or benztropine mesylate (Cogentin).
  • recommend riluzole (Rilutek) to aid with respiratory problems and some nerve damage
  • if the illness worsens, conduct a gastrostomy by placing a feeding tube into your stomach to aid in better nutrient digestion.

Be aware that riluzole is only approved by the FDA to treat ALS.

To treat pseudobulbar palsy, a physician might recommend:
  • Quinidine sulphate (Nuedexta) and hydrobromide can help lessen your episodes of laughing and sobbing.
  • medications, such as tricyclic antidepressants or selective serotonin reuptake inhibitors

How does the outlook differ for people with pseudobulbar vs. bulbar palsy?

The underlying cause determines how long pseudobulbar and bulbar palsy last. For instance, your symptoms might get better with time if your pseudobulbar palsy is the result of a stroke.

However, if your symptoms are brought on by a progressive illness, they can gradually get worse.

Respiratory failure associated with progressive bulbar palsy typically results in death and can happen within ten years of the onset of symptoms.


Bulbar palsy and pseudobulbar palsy are not the same neurological disorder, yet both have no known treatment.

Medication and rehabilitative therapy, nevertheless, can assist you in controlling the symptoms and enhancing your life.


Can pseudobulbar palsy be cured?

There's currently no cure for pseudobulbar palsy

How long does pseudobulbar last?

usually chronic (lifelong)

Is pseudobulbar serious?

The condition can be embarrassing and disruptive to your daily life.

Post a Comment