ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Bipolar Disorder and Epilepsy in Childhood: Clinical Challenges


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ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Bipolar Disorder and Epilepsy in Childhood: Clinical Challenges

Vol 1 - Iss 2 - Short Communication - Bipolar Disorder and Epilepsy in Childhood: Clinical Challenges #32

Bipolar Disorder and Epilepsy in Childhood: Clinical Challenges

Léon-Patrice Celestin MD1, Smadar Celestin-Westreich PhD2
1 26 rue de la Folier Regnault, 75011 Paris, France. Email: celestinlp@celestinpsy.com; Tel : +33 6 091 61 001
2 Vrije Universiteit Brussels, Belgium.

Purpose: Introduction of novel anti-epileptic drugs actualized the question of common neurobiological grounds for Bipolar Disorder and certain epilepsies. This study examines clinical challenges of cases in which childhood epilepsy is associated with later Bipolar Disorder diagnosis.

Methods: First, comorbidity of Bipolar Disorder and epilepsy was systematically reviewed. Second, a clinical case series (n=6) was analyzed with a developmental mapping procedure including relevant factors extracted from review (e.g. maternal/paternal family history, illness-onset ages, status epilepticus, interictal and bipolar mania characteristics, life events and medication follow-up). Patients (four boys, two girls) were first diagnosed and treated for epilepsy at ages 3 to 7, and re-examined following drug therapy discontinuation (ages 12 to 18).

Results: Prevalence of Bipolar Disorder in (mostly temporal lobe) epilepsy only recently became documented yet may amount to 8-10%. While childhood epilepsy is readily recognized, juvenile Bipolar Disorder remains underdiagnosed compared to prevalence estimates. All case mappings showed development of paroxystic manifestations following single/recurring epileptic episodes, presenting as fugues, theft, psychomotor agitation, or impulsive actings. One case also involved pseudoseizures sharing phenomenology with both Bipolar mania and epilepsy. Epilepsy treatment discontinuation in all cases was associated with expression of manifestations of Bipolar Disorder at puberty after traumatic life events. Family histories carried Bipolar Disorder antecedents.

Conclusions: Early-onset Bipolar Disorder requires focus of clinical investigation since it may go unnoticed in the context of overlapping symptoms with epileptic syndrome when these benefit from similar medication modalities. Further research on the comorbidity of Bipolar Disorder and epilepsy should allow to discriminate more effectively between manifestations of primary mania, secondary mania and pseudoseizures.

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