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ARTICLES: Alan B. Ettinger, Michael L. Reed, Joseph F. Goldberg, and Robert M.A. Hirschfeld Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders Neurology 2005; 65: 535-540 [Abstract] [Full text] [PDF]

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Reply to Duane

Alan B Ettinger, M.D., Michael L. Reed, M.D; Joseph F. Goldberg, M.D; Robert M.A. Hirschfeld, M.D.   (2 November 2005)

Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders

Drake D. Duane, M.D.   (2 November 2005)

Reply to Duane 2 November 2005
Alan B Ettinger, M.D., Long Island Jewish Medical Center, 270-05 76th Ave., New Hyde Park, NY 11040, Michael L. Reed, M.D; Joseph F. Goldberg, M.D; Robert M.A. Hirschfeld, M.D. Send Correspondence to journal: Re: Reply to Duane AEttinge{at}lij.edu Alan B Ettinger, M.D., et al.	We thank Dr. Duane for sharing preliminary results of his interesting study that approaches the issue of mood instability from a different perspective. While our study focused upon epilepsy, it notable that his study found utility of diverse antiepileptic treatments for bipolar disorder. We believe that further emphasis upon elucidating the nature and mechanisms of mood instability and frank bipolar disorder will be crucial in developing optimal management of mood instability in many chronic disorders. <P>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 (unrelated to the cited article).
Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders 2 November 2005
Drake D. Duane, M.D., Arizona State University/Institute for Developmental Behavioral Neurology 10210 North 92nd Street Suite 300, Scottsdale, AZ 85258 Send Correspondence to journal: Re: Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders dduane{at}arizonaneurology.com Drake D. Duane, M.D.	Utilizing the Mood Disorder Questionnaire (MDQ), Ettinger et al [1] observed a high incidence of bipolar symptoms in patients self- reported as epileptic. Half the subjects with bipolar symptoms by MDQ claimed a previous diagnosis of bipolar disorder. The authors suggest that antiepileptic drug therapy may be effective considering the relationship between altered brain physiology and mood. I submitted a related observation to the American Psychiatric Association 159th Annual Meeting. Forty-two referred patients (24 women, mean age 37 years) with a history of bipolar I or II (DSM-IV criteria) underwent a behavioral neurological assessment including EEG. [2] None of these patients received prior antiepileptic drug (AED) treatment. Eighteen (45%) had EEG abnormalities classified as a focal dysrhythmia grade III (Mayo Clinic classification) and twelve with dysrhythmia grade II (28%). In 21 of the 30 patients with EEG abnormalities (70%), AED therapy that included either lamotrigine, levetiracetam, topiramate or oxcarbazepine proved effective in stabilizing mood without serious adverse event in 18 (85%) over 6-60 months (mean 36). [3] Because none of these patients had a prior history of epilepsy, a diagnosis of interictal dysthymic disorder was excluded. [4] These observations confirm those of Ettinger et al's that physiologic assessment in behavioral disorders and behavioral assessment in epilepsy should be further investigated. References 1. Ettinger AB, Reed ML, Goldberg JF, Hirshfield MA. Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders. Neurology 2005; 65:535-540. 2. Duane DD. Frequency of EEG abnormalities and results of antiepileptic drug therapy in unstable mood disorders, 159th Annual Meeting of the American Psychiatric Association, scientific and clinical reports (accepted 11/1/05). 3. Post, RM. Differing psychotropic profiles of the anticonvulsants in bipolar and other psychiatric disorders. Clin NeurosciRes 2004; 4:9-30. 4. Blumer D. Antidepressant and double antidepressant treatment for the affective disorder of epilepsy. J Clin Psychiatry 1997; 58:3-11. Disclosure: The author reports no conflicts of interest.