Are seizure disorders and bipolar disorder related?

[Goldipeg]

My son is 15.  He had his first seizure when he was 6. He was diagnosed with complex partial seizure disorder.  I had taken him to a psychiatrist when he was 3 because of his severe temper tantrums.  She told me it was because he was delayed in his speech and had a hearing loss.  When Ryan had is last EEG in Nov 2002, it was normal.  The first normal EEG since he was 6.  We started tapering off Tegretol.  After a couple of months with less Tegretol, the mood swings and violent behavior started.  We never increased the Tegretol to more than 400 mg during that time.  However, after he tried to choke my husband and broke so many things in our home, I took him back to the psychiatrist.  He diagnosed Intermittent Explosive Disorder.  He raised his Tegretol the the dose he was taking before, 1000 mg.  Within a couple of weeks, he was better, but then one day he refused to go to school.  Then he threatened suicide several times.  He was cycling between being completely manic and running around to stopping and crying and saying he wanted to die.  I called the pdoc who said to call the police and have him admitted to the hospital.  He was then diagnosed with bipolar disorder.  He was also placed on Seroquel, which helped immensely.  My question is a lot of the behaviors he had when he was younger were consistent with bipolar disorder.  Are bipolar disorder and temporal lobe seizure disorder related?  Is it possible that he is having "deep brain" or "limbic area," seizures that are possible for the bipolar disorder?  Or could the EEG just have been wrong?  thank you!

[sandinmyears]

I have temporal lobe epilepsy (complex-partial and 2ndary generalized). I have been dx'd with ADHD and Bipolar II. I suspect that (in me) all three are one in the same. They are all related to a problem with neurotransmitters (dopamine in particular). They all (for me) create a deficit in the executive functioning part of my thinking process. My "working memory."

It's hard to tell what does what. For instance, the DILANTIN that I take to control my seizures can also bring on hyperactivity and confusion in people. Epilepsy (particularly temporal lobe epilepsy) can imitate Bipolar Disorder and I've even read a theory (though it is only a theory) that says Bipolar Disorder is a form of (non-convulsive) epilepsy.

Some similarities with TLE and BP are: hypergraphia (excessive writing and drawing....like this post of mine), cognitive perseveration (sticking with something forever and a day), non-linear thought processing (getting off track/going off on a tangent), obsessiveness, sleep problems, appetite problems, irritability, and depression. There are overlaps with ADHD and OCD, Asperger Syndrome and personality disorders. It gets confusing.  What makes things more confusing is that tests like EEG's are not fool-proof.  

My seizures are not pseudoseizures, however, as I had a left temporal partial lobectomy (surgery) in 1988.  There was a lesion in the left temporal lobe.  My seizures still occur but they are not as common.  Also, the seizures I now have affect my sense of smell (during the aura or simple-partial stage).  The seizures I had before my surgery did not affect my sense of smell.  I did not realize that many auras/seizure can can a person to imagine odors (olfactory sense) when I had my first post-surgical seizure.  If I did, I could see an argument that my post-surgical seizures are pseudo-seizures. My "new" seizures are very real. Also, I had many ADHD/Bipolar behaviors before my surgery.  

It is, however, possible that what doctors are diagnosing in me as "bipolar" might very well be my epilepsy.  I'm not sure if my shifts in appetite might be related to TLE.  (Before I was on Tegretol and Depakene, I would go up and down 10 pounds easily and in a short period of time because I would have no desire to eat for about 2 months and then for no apparent reason would start overeating for about the same length of time.  I also seem to have little need for sleep, but perhaps this is ADHD or TLE because this seems to be an ongoing thing (rather than in cycles).  (Unless what I have is "rapid cycling" or "mixed states").  I'm not sure how much of this might be related to the epilepsy itself.

I have an aunt with bipolar disorder and I my bipolar II was a recent diagnosis at a university hospital.  Since I am already on Neurontin, Tegretol and Dilantin for epilepsy, I have to wonder if I actually have Bipolar I but it is partially controlled with my AED's/mood stabilizers.  I recall having a couple "panic attacks" (lasting about 15 minutes each) before taking Tegretol and Depakene (now called Depakote/Valproic Acid--which I no longer take).  It's just so hard to know.

If you have partial seizures, (particularly temporal lobe), you may want to go to your library and check out the book "SEIZED" by Eve LaPlante.  I got it through an inter-library loan so don't give up if the library doesn't have it on hand.  You might also want to go to a search engine and type in 2 OR 3 of these words: INTERICTAL, GESCHWIND, "TEMPORAL LOBE," HYPERGRAPHIA, "FORCED NORMALIZATION," "VISCOSITY" or "STICKINESS."

Here's a link about the neuropsychiatric aspects of epilepsy:  http://www.harvard-magazine.com/issues/jf99/right.van.html

Email me if you want to "talk"
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[amato]

A related discussion, Is there any sponsor for him for free treatment? was started.

[Goldipeg]

Thank you very much.  His neurologist in Houston, Dr. Robert Zeller, was a professor of Child Neurology at UTMB in Galveston.  He did mention that the pattern of the abnormalities through the years on his EEG weren't normal.  Like it went from the left temporal lobe, to both temporal lobes, to the right then back to the left.  He said it was not typical.  I did bring him every EEG printout that I had, which was two and he looked over them.  He spent quite a bit of time going over them while we waited.  I just remember his comment that it was not typical, but that everyone is different.  Ryan was just unique, which I bought at the time.

Anyway, thank you very much. Peggy

[CCF-Neuro-M.D.-JT]

Although an increased risk of depression and suicidal tendencies is seen in seizure patients and there have been reports of mania following seizures, a number of research studies show that there is no increase in the incidence of bipolar disease among epileptic patients when compared to the general population. On the other hand, pseudoseizures are well known to be associated with bipolar patients. So the question now is this, were those truly epileptic seizures your son had in the past or just non-epileptic/pseudoseizures.  If there were true characteristic changes  on the EEG consistent with the diagnosis of a seizure, then there is no question that they were true neurologic seizures.  What you can do is try and get a copy of those EEGs (not just the report) and have them read at a major epilepsy center as a consult.  EEGs can sometimes be difficult to read and it takes an experienced and well trained neurologist to make the definitive call in tough cases. Hope that helps. Good luck to your son and your family.