Symptoms Of Progressive Bulbar Palsy

Progressive bulbar palsy is a neurological disease that affects an individual's ability to chew, swallow, and speak. This disease attacks the brain stem, causing atrophy of the motor neurons. Progressive bulbar palsy is considered a variant of the disease amyotrophic lateral sclerosis (ALS), which also attacks the nerves of the brain stem and spinal cord. Research indicates many of the individuals who develop progressive bulbar palsy also develop ALS later in their lives. Unfortunately, there is no cure for progressive bulbar palsy at this time. However, physicians can work with patients to treat the symptoms that emerge as a result of the disease. Get to know the common symptoms of progressive bulbar palsy now.

Weak Facial Muscles

As progressive bulbar palsy attacks the brain stem, it damages the nerves that control the motor functions of the face and jaw. This damage results in weak facial muscles. An individual with progressive bulbar palsy may have difficulty smiling, frowning, or otherwise showing emotion through facial expressions, resulting in what may be deemed as an expressionless face. The weakness in the facial muscles may be minor in the beginning stages of the disease but will progress as the motor neurons are destroyed as the disease advances throughout the brain stem. Unfortunately, there is currently no treatment available to reverse weakening of the facial muscles. Treatment may consist of physical therapy to slow the progression of muscle atrophy.

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Progressive Loss Of Speech

Another symptom of progressive bulbar palsy is the progressive loss of speech. As the disease advances, it weakens and inevitably destroys the tongue muscles. The inability to move the tongue results in a decreased ability for word formation. Difficulty swallowing also leads to the retention of fluids in the mouth and nasal passages, leading to speech patterns that sound nasally as well as difficulty forming consonants. The loss of speech may be minor at first and can be treated with speech therapy. It is important for patients to understand while treatment may slow speech loss, it will not stop the eventual progression and deterioration of their ability to speak.

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Difficulty Swallowing

Difficulty swallowing is one of the first symptoms to emerge at the onset of progressive bulbar palsy. The jaw, lips, and tongue typically assist in the reflex of moving fluids and food to the stomach when swallowing. However, because progressive bulbar palsy damages the nerves that regulate the swallowing reflex, the muscles in the mouth and throat become atrophied, making it difficult for an individual to swallow and control the saliva that accumulates in their mouth. Some of the first signs an individual is having problems swallowing are coughing when eating food or drinking liquids; having to swallow more than normal to move liquids, food, or saliva from the mouth; and food, saliva, or liquid expelling from the mouth. Individuals with swallowing issues may be referred to a speech therapist for assistance with managing the limitation, as well as a dietitian who can help patients change their diet to meet the needs of their body.

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Emotional Lability

Emotional lability is defined as the experience of uncontrollable laughter or crying as well as involuntary and sometimes inappropriate expression of emotion. Some individuals with progressive bulbar palsy develop difficulty in controlling their emotional responses. It is not entirely understood exactly why this occurs in some patients with the disease, but not others, but research indicates this may be due to the atrophy experienced in the lower brain nerves and muscles. Minor emotional lability may not require treatment, but for more severe cases, or for those cases in which outbursts are causing a fair amount of stress to the patient, physicians may opt to recommend treatments often given to individuals with depression to manage symptoms and provide relief.

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Jaw Weakness

Jaw weakness is another symptom of progressive bulbar palsy. The jaw has many functions, including assisting with the chewing and processing of food, speech, and facial movements. When there is a significant weakness of the jaw muscles, a patient may be rendered unable to chew, talk, or swallow. Signs of weakness in the jaw include the inability to fully close the mouth; slackness in the muscles, resulting in the face appearing lopsided at the jaw; fatigue when chewing food or speaking; and limited facial expressions. Jaw weakness is typically progressive, and in some cases, the muscles in the jaw become completely atrophied and unable to be used. Patients may be referred to a speech therapist to work on jaw exercises to slow the progression of the disease. As progressive bulbar palsy advances and the atrophy becomes increased, patients may need to change their diet to soft or liquid foods. If the weakness advances to such a state in which the jaw can no longer function for eating, a feeding tube may need to be inserted to assist with proper nutrition.