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From the Department of Neurology (Dr. Ettinger), Long Island Jewish Medical Center, New Hyde Park, NY; Vedanta Research (Dr. Reed), Chapel Hill, NC; Bipolar Disorders Research Program (Dr. Goldberg), Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore Long Island Jewish Health System, Glen Oaks, NY; and Department of Psychiatry &Behavioral Sciences (Dr. Hirschfeld), University of Texas Medical Branch, Galveston.
Address correspondence and reprint requests to Dr. Alan B. Ettinger, EEG Lab, Long Island Jewish Medical Center, 270-05 76th Ave., New Hyde Park, NY 11040; e-mail: aettinge{at}lij.edu
Objective: To estimate the comparative prevalence of bipolar symptoms in respondents with epilepsy vs other chronic medical conditions.
Methods: The Mood Disorder Questionnaire (MDQ), a validated screening instrument for bipolar I and II symptoms, in conjunction with questions about current health problems, was sent to a sample of 127,800 people selected to represent the US adult population on selected demographic variables. A total of 85,358 subjects (66.8%) aged 18 or older returned the survey and had usable data. Subjects who identified themselves as having epilepsy were compared to those with migraine, asthma, diabetes mellitus, or a healthy comparison group with regard to relative lifetime prevalence rates of bipolar symptoms and past clinical diagnoses of an affective disorder.
Results: Bipolar symptoms, evident in 12.2% of epilepsy patients, were 1.6 to 2.2 times more common in subjects with epilepsy than with migraine, asthma, or diabetes mellitus, and 6.6 times more likely to occur than in the healthy comparison group. A total of 49.7% of patients with epilepsy who screened positive for bipolar symptoms were diagnosed with bipolar disorder by a physician, nearly twice the rate seen in other disorders. However, 26.3% of MDQ positive epilepsy subjects carried a diagnosis of unipolar depression, and 25.8% had neither a uni- nor bipolar depression diagnosis.
Conclusion: Bipolar symptoms occurred in 12% of community-based epilepsy patients, and at a rate higher than in other medical disorders. One quarter were unrecognized.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the August 23 issue to find the title link for this article.
Disclosure: The Epilepsy Impact Project was supported by GlaxoSmithKline, Inc. (GSK). Dr. Ettinger has received honoraria from GSK. Drs. Reed, Goldberg, and Hirschfeld have received honoraria from GSK in excess of $10,000. Dr. Goldberg has also participated in an advisory board sponsored by GSK. The epilepsy division at Long Island Jewish Medical Center has received grants in excess of $10,000 from GSK for studies of lamotrigine, which were unrelated to the current manuscript.
Received January 25, 2005. Accepted in final form May 6, 2005.
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  M. Mazza, M. Di Nicola, G. D. Marca, L. Janiri, P. Bria, and S. Mazza Bipolar Disorder and Epilepsy: A Bidirectional Relation? Neurobiological Underpinnings, Current Hypotheses, and Future Research Directions Neuroscientist, August 1, 2007; 13(4): 392 - 404. [Abstract] [PDF]
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D. D. Duane, A. B. Ettinger, M. L. Reed, J. F. Goldberg, and R. M.A. Hirschfeld Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders Neurology, March 28, 2006; 66(6): 954 - 954. [Full Text] [PDF]
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