{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:51:19Z","timestamp":1791885079739,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2010,9,13]],"date-time":"2010-09-13T00:00:00Z","timestamp":1284336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2010,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate dextromethorphan combined with ultra low\u2010dose quinidine (DMq) for treating pseudobulbar affect (PBA) in patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a 12\u2010week randomized, double\u2010blind trial, ALS and MS patients with clinically significant PBA (a baseline score \u226513 on the Center for Neurologic Studies\u2013Lability Scale [CNS\u2010LS]) were maintained, twice daily, on placebo, DMq at 30\/10mg (DMq\u201030), or DMq at 20\/10mg (DMq\u201020).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 326 randomized patients (of whom 283, or 86.8%, completed the study), the PBA\u2010episode daily rate was 46.9% (<jats:italic>p<\/jats:italic>&lt; 0.0001) lower for DMq\u201030 than for placebo and 49.0% (<jats:italic>p<\/jats:italic>&lt; 0.0001) lower for DMq\u201020 than for placebo by longitudinal negative binomial regression, the prespecified primary analysis. Mean CNS\u2010LS scores decreased by 8.2 points for DMq\u201030 and 8.2 for DMq\u201020, vs 5.7 for placebo (<jats:italic>p<\/jats:italic>= 0.0002 and<jats:italic>p<\/jats:italic>= 0.0113, respectively). Other endpoints showing statistically significant DMq benefit included, for both dosage levels, the likelihood of PBA remission during the final 14 days and, for the higher dosage, improvement on measures of social functioning and mental health. Both dosages were safe and well tolerated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>DMq markedly reduced PBA frequency and severity, decreasing the condition's detrimental impact on a patient's life, with satisfactory safety and high tolerability. The findings expand the clinical evidence that DMq may be an important treatment for patients suffering from the socially debilitating symptoms of PBA. 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