Bipolar affective disorder and epilepsy

Author/s
Mariusz S. Wiglusz, Mark Agius, Krzysztof Krysta, Wieslaw J. Cubala
Citation
Issue 3 Summer 2013
CEPiP.2013;1:299-305
Abstract

The comorbidity of epilepsy and mood disorders has been a subject of interest and of many studies for decades. Although the data on the prevalence of bipolar disorder in epilepsy is still limited, there is growing evidence that these disorders are frequently comorbid. Bipolar disorder and epilepsy have a number of clinical, biochemical and pathophysiological features in common.

Mood disorders in epilepsy often have atypical symptomatology and fail to meet DSM-IV-TR criteria. They can be classified according to the temporal relationship between the onset of psychiatric symptoms and seizure occurrence into ictal (as a clinical manifestation of the seizure), peri-ictal (symptoms precede [pre-ictal] and/or follow [postictal] the seizure), and interictal (symptoms occur independently of the seizure occurrence).

A pleomorphic affective syndrome in patients with epilepsy has been named interictal dysphoric disorder (IDD). Recent data suggest that some symptoms of IDD can be related rather to bipolar spectrum disorder than to unipolar depression, which has implications for treatment and prognosis.

Keywords: epilepsy, bipolar disorder, interictal dysphoric disorder, kindling

Cite as: Cutting Edge Psychiatry in Practice 2013, 3(1):299-305; https://doi.org/10.65031/hjpw9102

References

  1. Chang BS, Lowenstein DH. Epilepsy. N Engl J Med. 2003; 349: 1257–66.           
  2. Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R. How common are the ‘common’ neurologic disorders? Neurology 2007; 68: 326–37. https://doi.org/10.1212/01.wnl.0000252807.38124.a3
  3. Lehrner J, Kalchmayr R, Serles W, Olbrich A, Pataraia E, Aull S, Bacher J, Leutmezer F, Gröppel G, Deecke L, Baumgartner C. Health-related quality of life (HRQOL) activity of daily living (ADL) and depressive mood disorder in temporal lobe epilepsy patients. Seizure 1999; 8: 88-92. https://doi.org/10.1053/seiz.1999.0272
  4. Boylan LS, Flint LA, Labovitz DL, Jackson SC, Starner K, Devinsky O. Depression but not seizure frequency predicts quality of live in treatment resistant epilepsy. Neurology 2004; 62: 258-61. https://doi.org/10.1212/01.wnl.0000103282.62353.85
  5. Barry JJ, Anna Lembke in Affective Disorders in Epilepsy in Psychiatric Issues in Epilepsy. A Practical Guide to Diagnosis and Treatment. Lippincott Wiliams & Wilkins, 2007, 2-nd edition; 203-47.              
  6. Hermann BP, Seidenberg M, Bell B. Psychiatric comorbidity in chronic epilepsy: identification, consequences, and treatment of major depression. Epilepsia 2000; 41: 31– 41. https://doi.org/10.1111/j.1528-1157.2000.tb01522.x
  7. American Psychiatric Association. (1994) Diagnostic and statistical manual of mental disorders. 4th ed. American Psychiatric Association, Washington, D.C. https://doi.org/10.1007/springerreference_179660
  8. Judd L, Akiskal HS. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord. 2003; 73: 123–31. https://doi.org/10.1016/s0165-0327(02)00332-4
  9. Soldani F, Sullivan PF, Pedersen NL. Mania in the Swedish Twin Registry: Criterion validity and prevalence. Aust N Z J Psychiatry. 2005; 39: 235–43. https://doi.org/10.1111/j.1440-1614.2005.01559.x
  10. Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr, Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS, Zajecka J. Development and validation of a screening instrument for bipolar spectrum disorder: the mood disorder questionnaire. Am J Psychiatry 2000; 157: 1873–5. https://doi.org/10.1176/appi.ajp.157.11.1873
  11. J. Angst, R. Adolfsson, F. Benazzi, A. Gamma, E. Hantouche, T.D. Meyer, P. Skeppar, E. Vieta, J. Scott. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 2005; 84: 217–33. https://doi.org/10.1016/j.jad.2005.05.011
  12. Swinkels WA, Kuyk J, van Dyck R, Spinhoven P. Psychiatric comorbidity in epilepsy. Epilepsy Behav. 2005; 7: 37-50. https://doi.org/10.1016/j.yebeh.2005.04.012
  13. Wolf P. Manic episodes in epilepsy. In: Akimoto H, Kazamatsuri H, Seino M, Ward Jr AA, editors. Advances in epileptology: XIIIth epilepsy international symposium. New York: Raven Press; 1982. 237–40.                 
  14. Alliez J, Roger J, Mialle MF. Epilepsie et psychose maniaco-dépressive: coexistence ou corrélations? Ann Med Psychol (Paris) 1978; 136: 1057–68.
  15. Ettinger AB, Reed ML, Goldberg JF, Hirschfeld RM. Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders. Neurology 2005; 65: 535–40. https://doi.org/10.1212/01.wnl.0000172917.70752.05
  16. Mula M, Jauch R, Cavanna A, Collimedaglia L, Barbagli D, Gaus V, Kretz R, Viana M, Tota G, Israel H, Reuter U, Martus P, Cantello R, Monaco F, Schmitz B. Clinical and psychopathological definition of the interictal dysphoric disorder of epilepsy. Epilepsia. 2008; 49: 650-6. https://doi.org/10.1111/j.1528-1167.2007.01434.x
  17. Jess G. Fiedorowicz, Jean Endicott, Andrew C. Leon, David A. Solomon, Martin B. Keller, William H. Coryell Subthreshold Hypomanic Symptoms in Progression From Unipolar Major Depression to Bipolar Disorder Am J Psychiatry. 2011; 168: 40–8. https://doi.org/10.1176/appi.ajp.2010.10030328
  18. Goddard GV, McIntyre DC, Leech CK. A permanent change in brain function resulting from daily electrical stimulation. Exp Neurol. 1969; 25: 295–330 https://doi.org/10.1016/0014-4886(69)90128-9
  19. Bertram E. The relevance of kindling for human epilepsy. Epilepsia 2007; 48 (Suppl 2): 65–74 https://doi.org/10.1111/j.1528-1167.2007.01068.x
  20. Post RM, Uhde TW, Putnam FW, Ballenger JC, Berrettini WH. Kindling and carbamazepine in affective illness. J Nerv Ment Disord 1982; 170: 717–31. https://doi.org/10.1097/00005053-198212000-00002
  21. Post RM, Weiss SR. A speculative model of affective illness cyclicity based on patterns of drug tolerance observed in amygdala-kindled seizures. Mol Neurobiol. 1996; 13: 33–60. https://doi.org/10.1007/bf02740751
  22. Löscher W, Fisher JE, Nau H, Hönack D.. Valproic acid in amygdala kindled rats: alterations in anticonvulsant efficacy, adverse effects and drug and metabolite levels in various brain regions during chronic treatment. J Pharmacol Exp Ther 1989; 250: 1067–78. https://doi.org/10.1016/s0022-3565(25)22759-8
  23. O’Donnell RA, Miller AA. The effect of lamotrigine upon development of cortical kindled seizures in the rat. Neuropharmacology 1991; 30: 253–8. https://doi.org/10.1016/0028-3908(91)90152-2
  24. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Bipolar Disorder (Revision). Am J Psychiatry. 2002; 159 (suppl 4): 1–50.
  25. Goodwin GM; Consensus Group of the British Association for Psychopharmacology. Evidence- based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2003; 17: 149–173. https://doi.org/10.1177/0269881103017002003
  26. Jonathon Holland, Dr Richard Doughty, Dr Mark Agius, Dr Rashid Zaman Bipolar Disorder, Migraine, Epilepsy – a shared pathogenesis? e-poster EPA 2012 https://doi.org/10.2174/2211556011302020001
  27. Kato T. Molecular neurobiology of bipolar disorder: a disease of ‘mood-stabilizing neurons’? Trends Neurosci. 2008; 31: 495-503. https://doi.org/10.1016/j.tins.2008.07.007
  28. Rogawski MA, Löscher W. The neurobiology of antiepileptic drugs for the treatment of nonepileptic conditions. Nat Med. 2004; 10: 685-92. https://doi.org/10.1038/nm1074
  29. Scharfman, HE, Brain-derived Neurotrophic Factor and Epilepsy—A Missing Link? Epilepsy Curr. 2005; 5: 83–8. https://doi.org/10.1111/j.1535-7511.2005.05312.x
  30. Blanchet P, Frommer GP. Mood change preceding epileptic seizures. J Nerv Ment Dis 1986; 174: 471– 6. https://doi.org/10.1097/00005053-198608000-00005
  31. Williams D. The structure of emotions reflected in epileptic experiences. Brain 1956; 79: 29–67. https://doi.org/10.1093/brain/79.1.29
  32. Kanner AM, Palac S. Depression in epilepsy: a common but often unrecognized comorbid malady. Epilepsy Behav 2000; 1: 37–51. https://doi.org/10.1006/ebeh.2000.0030
  33. Mula M, Jauch R, Cavanna A, Gaus V, Kretz R, Collimedaglia L, Barbagli D, Cantello R, Monaco F, Schmitz B. Interictal and periictal dysphoric symptoms in patients with epilepsy. Epilepsia. 2010; 51: 1139–45. https://doi.org/10.1111/j.1528-1167.2009.02424.x
  34. Kanner AM, Barry JJ. Is the Psychopathology of Epilepsy Different from That of Nonepileptic Patients? Epilepsy Behav. 2001; 2: 170-86. https://doi.org/10.1006/ebeh.2001.0192
  35. Kanner AM, Rabinovich A, Soto A. The prevalence of postictal symptoms of depression in patients treated in tertiary epilepsy centers: a transcultural perspective. Epilepsia. 1999; 40 (suppl 2): A147.     
  36. Daly D. Ictal affect. Am J Psychol 1958; 115: 97–108.     
  37. Mendez MF, Doss R. Ictal and psychiatric aspects of suicide among epileptics. Int J Psych Med 1992; 22: 231–8. 
  38. Boylan LS. Peri-ictal behavioral and cognitive changes. Epilepsy Behav. 2002; 3:16–26. https://doi.org/10.1006/ebeh.2001.0305
  39. Kanner AM, Soto A, Gross-Kanner H. Prevalence and clinical characteristics of postictal psychiatric symptoms in partial epilepsy. Neurology. 2004; 62: 708–13. https://doi.org/10.1212/01.wnl.0000113763.11862.26
  40.  
  41.  
  42.  
  43.  
  44.  
  45.  
  46.  
  47.  
  48.  
  49.  
  50. Nishida T, Kudo T, Inoue Y, Nakamura F, Yoshimura M, Matsuda K, Yagi K, Fujiwara T. Postictal mania versus postictal psychosis: differences in clinical features, epileptogenic zone, and brain functional changes during postictal period. Epilepsia. 2006; 47: 2104–14. https://doi.org/10.1111/j.1528-1167.2006.00893.x
  51. Blumer D, Montouris G, Davies K. The interictal dysphoric disorder: recognition, pathogenesis, and treatment of the major psychiatric disorder of epilepsy. Epilepsy Behav 2004; 5: 826–40. https://doi.org/10.1016/j.yebeh.2004.08.003
  52. Kraepelin E. Psychiatrie, vol. 3. Leipzig: Johann Ambrosius Barth; 1923.           
  53. Mula M, Schmitz B, Jauch R, Cavanna A, Cantello R, Monaco F, Trimble MR. On the prevalence of bipolar disorder in epilepsy. Epilepsy Behav 2008; 13: 658–61. https://doi.org/10.1016/j.yebeh.2008.08.002
  54. Mula M. The clinical spectrum of bipolar symptoms in epilepsy: a critical reappraisal. Postgrad Med. 2010; 122: 17-23. https://doi.org/10.3810/pgm.2010.07.2171