Delivery Experience & Current Symptoms
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Q:  Delivery Experience & Current Symptoms

My now 16 year old son has been struggling with Bipolar for a while now.  I am blessed in that he has every treatment available for him without a "custody-bow-out", as so many parents do...but there are still alot of problems....He's a major rapid-cycler, going 0-100 in 4 seconds flat...He has problems with judgement, impulse control, thought patterns, logical thinking and reasoning, etc...(i've gone through the diagnostic alphabet with him). His body may be 7/8 grown, but mentally and emotionally he is maybe 10 years old. I guess what I'm wanting to know is...He was delivered using a 'plunger' like device (he got stuck).  His head was so warped, like a peanut with one nut...I have pictures of his birth, and it appears that there could have possibly been damage to frontal and parital lobes (top, both sides) and left temporal lobe. I understand that the deficits he has is controlled in these sections of the brain? Is there any research at all out there to support this?  and, how can I find out if there is a problem, and, how can I help him? I know I'm not the only one out there that wonders this... Thank you for your time.


Dear Teresa -- 
If there was a connection between his experience at delivery and his current symptoms, I'm not aware of any way in which this would change the treatment approaches you have to consider -- except that you'd probably want to ask whether an EEG (electroencephalogram) would be useful.  Perhaps that's been done.  As you probably know, it's a tool to look for "seizure activity" in the electrical activity that's near enough to the surface to measure. If there is no such "seizure activity", which means some unusual patterns of brain waves that are known to be associated with seizures, that doesn't mean it isn't there, it just means the test didn't see any. But if the test did show such activity, then his treatment might more strongly emphasize the mood stabilizers with anti-seizure effects ("anticonvulsants" like Depakote, carbamazepine, and lamotrigine, primarily) as he and his doctors work their way through the options. 

But I'm not a developmental specialist nor a neurologist, so I could be missing something here. Don't take my word as definitive.  In my experience, even when we know there is a neurologic abnormality, if that problem cannot be addressed in some way by the neurology team, then we psychiatrists end up treating the symptoms in much the same way we'd treat anybody else.  For many people it still makes a difference to know, to "see" the abnormality on a test like an EEG or MRI, so that there's something more concrete to point at. But that's expensive; our health care system can't really afford what we're doing even now, let alone adding these kinds of tests for everybody.  We reserve them more for patients like your son where there's some reason to look; and some way in which treatment might change (as with the anticonvulsant emphasis) depending on the results. Good luck with all that. 

Dr. Phelps

Published February, 2006


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