What are Bipolar Seizures?
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Q:  What are Bipolar Seizures?

My husband has been diagnosed with bipolar disorder for the last 4 years.  About two years ago he started having seizures.  Just recently after a hospital stay at a medical university, the doctors stated he was not having seizures per say  but he was having bipolar seizures.  They would not elaborate more on the subject except that the doctor will explain it more when we visit him in his office.  That appointment is not for 2 1/2 months down the road.  Could you tell me what bipolar seizures are?

Dear Ms. M --

This is tricky territory. I cannot be certain what the doctors mean, as there is officially no such thing as "bipolar seizures". On the other hand, bipolar disorder itself is remarkably like epilepsy in some ways. For example, many patients with bipolar disorder get better when treated with an anticonvulsant, a medication for seizures. Similarly, some of the things that make seizures worse, make bipolar disorder worse: sleep deprivation and alcohol, for example.

So it could be that the doctors think your husband is right on the edge between these two conditions (although, to be completely clear, the idea that the two conditions exist right next to one another, with perhaps some "intermediate cases", has not been established; thinking of them as perhaps related in some way is based on the ways in which they seem related, not on some biologic understanding).

Then there is an even more confusing territory, which may or may not apply to your husband's situation, often referred to as "pseudo-seizures". This is what the neurologists call it when someone has what appear to be seizures that do not have the other characteristic signs of epileptic seizures. The most concrete sign is an "EEG", an electroencephalograph. If a neurologist obtains an EEG during a seizure, and there is no seizure-like activity on the EEG graph, and a very commonly call this a "pseudo-seizure". By this they mean that, although the patient has what looks like a seizure, is not a true epileptic seizure. What is it then?

Well, "not sure" might be the most honest answer. Again, this may not apply to your husband, particularly if the term pseudoseizures does not come up. This term has a long history, and until recently, it often implied that the neurologists thought the patient was "faking it" in some way. More recently, the neurologists seem to have grasped that the story is vastly more complicated than that. And, one must always remember, the EEG is not a perfect test. It is looking for abnormal electric activity coming from the surface of the brain. If the site producing abnormal activity is deeper in the brain, the EEG may not be able to detect it. In that case, neurologist may use the term pseudoseizure even when there is truly a seizure-like phenomenon going on.

The bottom line from all this: sometimes determining exactly whether a set of behaviors that in some respects look like a "seizure" is truly epileptic, or has some other basis, is very difficult even for the best experts. The good news, however, is that many of the same treatments applied whether a person has bipolar disorder or a seizure disorder -- so in many cases, it is not crucial to determine exactly which one a patient has. We just get on with treatment.

Good luck trying to figure this out. I would encourage you to try to withhold judgment about the whole thing, including the diagnostic terms used and even the working framework the doctors seem to be using. What really matters, in the end, is getting a good treatment response. Try to help everyone keep their eyes on that prize.

Dr. Phelps

Published April, 2008


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