Does This Sound Like BP
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Q:  Does This Sound Like Bipolar

I need to know if this sounds like a bipolar child. My son who is 14 headed a soccer ball in Jan. Since then the day after he got the flu. THree days later he woke up and could not talk. THen he got volgar. After that he reverted to like a child. He was in 2 hospitals had MRI, EEG, CTscan, Spinaltap, bloodtest, urinetest, strepttest, thyroidtest, chestexrays. No one knows what this is. He was diagnosed with Severe Extreme Sinusitis. And that was all they could find. He has these episodes every 2 weeks. And lasts 4-5days. This last time he actaully went almost 5 weeks being ok. When this happens all he wants to do is sleep and he will sleep all day for those 4-5 days if I let him.When he comes out of this he does not remember hardly anything. My Question is does this sound like a bipolar person? He is seeing a Phyciatrist now. And is on Seroquel, and Welburtrin. I just need a direction to go or someone to help me find the right help for him.


Dear Robin -- 
There are two things that stick out here which are not very consistent with bipolar disorder.  First and most important, is your statement "When he comes out of this he does not remember hardly anything".  That is much, much more typical of a seizure-type problem.  Now as you've probably learned, seizures aren't supposed to go on for 4-5 days.  And it's pretty typical of bipolar disorder to have phases where somebody wants to sleep all day, alternating with phases of severe symptoms that could include "vulgar" (where that was not characteristic of the person otherwise).  

If there was a clear history in your family of bipolar disorder, I'd be more suspicious of that (or having at least on person in each generation above him with some severe mood problems; or profound alcohol problems, with multiple affected people in each generation).  I'd also be more suspicious if during those times when he wants to sleep so much he's depressed: low energy, low motivation, can't enjoy things.  

The other thing that sticks out it the "he could not talk" part.  That's more typical of some serious neurological problem, and is seen only in the most severe forms of bipolar disorder.  

Some seizure problems can't be seen with routine EEG.  I'd look for a second neurologic opinion, and maybe a third, and see if you can get an EEG when he's clearly having profound symptoms (and maybe a comparison when he's not).  

And eventually we treat bipolar and seizures almost the same anyway, and there's some reason to think that bipolar disorder is pretty close to a "seizure disorder" in some ways anyway, so you could just start treating this as though it were bipolar disorder: even if it were a seizure disorder, you could get a good result.  I'm surprised he's not on an anticonvulsant, of the type that we routinely use for bipolar disorder (Depakote, Trileptal, or lamotrigine); maybe those were already tried?  That would be one way to go, you see: just treat it and see if it gets better, even if you're not sure what it is (i.e. and skip, or postpone, the further diagnostic evaluations, until you see where you can get with this approach).  

In any case, I'm sure this must be terrible to have to watch, such a transformation, and I hope something good comes of all your efforts soon. 

Dr. Phelps

Published May, 2002 


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