Q: Does this Sound like Seizures or Bipolar Disorder?|
You may be our guardian angel. Our daughter 8, has had mean with extremely odd
mood swings since 2. She has generalized seizures (front lobes), but doctors
don't think it could cause such weird moods. It is strange that she wakes up
every morning fine, then she slips into this very irritable difficult mood, with
no focus. It happens everyday. We have her eating fish and veggies, to see if
its a food allergy, but its no help. She bumps into things, can't complete a
task when the reaction starts. Her eyes have a black look to them, and they
seem to shift back and forth slightly. My husbands mother has epilepsy, and my
brother has ocd. I don't know of any bi-polar in the family. We had her on
trileptal, which improved her focus, but she had a bad rash from it. Going to
bed at night is the worst! She starts hitting and going completely odd. We are
totally lost. The slightest bit of sugar or starch seems to make her worse. You
sound like your very compassionate and we are praying for some advice from you
that may help. She does want to hurt herself and me (her mother) when she is
feeling really out of control. She only gets really out of control after eating
sugar. and some packaged foods. Does this sound like the seizures or bi-polar to
Dear Ms. C. --
Bipolar or epilepsy? Let's see, does it really matter at this point?
In the long run, it will matter: it may give you a sense of prognosis -- how
this is likely to look over time. For example, in epilepsy, the goal would be to
have no such symptoms, and you would not expect to have any mood symptom
problems showing up either. By comparison, in bipolar disorder, you might get
these major symptoms under control yet still see some mood symptoms showing up
from time to time.
Nevertheless, in each case, the goal would be to press forward, pursuing
treatment options, until symptoms or behaviors that seemed to be associated with
some sort of sudden shift in focus and energy were no longer occurring. The
reason for this goal is that when both bipolar disorder and epilepsy, the
current working supposition is that when some symptoms remain, the condition is
more likely to continue to default, potentially becoming more difficult to
treat, over time. This does not happen in everyone, but it happens often enough
to keep making us want to pursue that goal of "zero symptoms".
Therefore, in your daughter's case, right now I'm not sure that it makes very
much difference whether you think of this as epilepsy or as bipolar disorder.
The goal is the same: her symptoms sound sufficiently severe to warrant a fairly
aggressive effort to get them under control. One anticonvulsant, Trileptal, has
so far shown some benefit. There are numerous others which have also been used
in the treatment of bipolar disorder. So the least to consider those options,
differentiating between these two diagnostic ways of thinking is not crucial.
These anticonvulsants include lamotrigine -- which also can cause a rash, quite
often in children, and so must be started with great caution, beginning with as
little as one quarter of the usual standard recommended doses for starting an
adult. (The typical starting dose in an adult is 25 mg, and when I am trying to
be ultra-cautious, even in an adult, I will use the 5 mg pediatric dose,
increasing by that increment per week. You could discuss that with your
daughter's current physician -- whether that is a neurologist, or a
psychiatrist, both should be familiar with this strategy.
Since lamotrigine is not associated with weight gain, as is the other main
alternative, Depakote, it may be preferable even though the rash risk is
definitely of concern. By comparison, Depakote (although it too can cause a
rash, though more rarely) can cause a problem called polycystic ovarian syndrome
(PCOS) which is associated with both weight gain and some hormone changes that
are not good, especially in a young girl.
After anticonvulsants, then the issue about diagnosis becomes more prominent,
because then there are numerous other medication approach is for these kinds of
symptoms, but they are not routinely used in epilepsy, and some of them can
actually make an epileptic condition somewhat worse (particularly a family of
medications which technically are "antipsychotics";
see that link to understand why such a medication could be of value even though
her symptoms do not currently include psychosis).
But for now, the fact that she "bumps into things" when their reaction starts,
still -- in my view, based on what you have written here -- makes the "seizure"
way of thinking about all this more appropriate. That is, bipolar disorder does
not cause such problems with muscle control, or balance, or whatever might be
the basis of this symptom your daughter experiences. If in the long run this is
indeed more like an epilepsy condition, continuing to pursue help from
neurologists, including second or third opinions, would end up being more
productive than seeing a psychiatrist.
There is a test called a "video EEG", where the patient has brain recordings
obtained while his or her behavior is filmed, so that correlation between the
two can be drawn if possible. If your daughter has not had this, that might be
worth asking about. Unfortunately, however, if it is "negative"; meaning that
the test is not demonstrate a connection between brain activity and behaviors;
this does not necessarily mean that the basis of the behavior is
"psychological". It could still be a seizure condition that the test cannot
detect, for example because the starting point for the seizure is too deep in
the temporal lobe, where the test is not very sensitive. When this test is
negative, there is a tendency for the neurologists to use the term
"pseudo-seizures", which in my experience means "we cannot be held responsible
for treating this, it is not our problem, you need to see a psychiatrist". I
mention this just to warn you that even if that is what you are told ("pseudoseizures"),
this does not necessarily mean you should give up on the neurologic angle, i.e.
the possibility that this is a seizure-like condition more than a mood-based
condition. This is the point at which a second or third neurologic opinion could
be useful. All of this may require going to multiple specialists, or even
significant travel to a regional specialty center.
I hope some of that might be of use. Good luck with the process --
Published January, 2008