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PBA is a condition characterized by episodes of uncontrollable laughing and/or crying that may be inappropriate, unrelated to the situation at hand, or not expressing the person's mood. The condition is known by other terms, including emotional lability, emotional incontinence, and pathological laughing and crying.

If you or someone you know experiences episodes of uncontrollable laughing and/or crying, you may be eligible to participate in a clinical study now underway to find a treatment for pseudobulbar affect (PBA).

Interest Form

1. To get started please select whether you are patient/caregiver or healthcare professional:

2. What is your professional designation?
MD
RN
RPh
Other

3. What is your specialty?
Neurology
Psychiatry
Other

4. Contact Information
*Required Field
First Name*
Middle Name
Last Name*
Email
Phone*
Fax
Address 1*
Address 2
City*
State*
Zip*
Country

5. Do you want to receive additional information about the STAR trial?
Yes
No

6. Are you interested in becoming a STAR trial investigator?
Yes
No

Comments

2. Date of Birth*
Month, Day, Year
*(Must be between 18 and 80 years old to participate)

3. What is your gender (sex)?
Female
Male	(Skip to question 5)

4. Are you currently pregnant, breastfeeding, or planning to become pregnant during the course of the study?
Yes
No

5. Have you been diagnosed with pseudobulbar affect (also known as emotional lability) by a health care professional?
Yes
No

6. Do you have a diagnosis of amytotrophic lateral sclerosis (ALS) or multiple sclerosis (MS)?
Yes
No

7. Have you experienced uncontrollable and/or involuntary episodes of laughter and/or crying?
Yes
No

8. What is your preferred contact method?
Email
Phone

9. Contact Information
*Required Field
First Name*
Middle Name
Last Name*
Email
Phone*
Address 1*
Address 2
City*
State*
Zip*
Country
Comments



Interest Form Disclaimer: This form is not intended for use as a diagnostic or assessment tool for pseudobulbar affect (PBA). Please see the Terms of Use and Privacy Policy

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