Introduction

A number of studies have examined the occurrence of affective disorders in the context of epilepsy, but these studies generally focus on depression, and few have focused on mania.1 There are case reports of patients with epilepsy experiencing postictal manic symptoms. In this situation, there is generally a four-sequence period of lucidity, mania, hypomania and remission.2. In individuals with epilepsy, the prevalence of bipolar disorder is only 1.5%, whereas the prevalence of postictal mania is 11.8%. 34. This case report reveals a patient with past medical history of epilepsy with no reported psychiatric history of depression or mania who presented with two recent episodes of mania with no recent seizures reported by the patient or his family who had closely observed him for the preceding two months..

Case Presentation

A 32 year old male with a history of epilepsy presented to the psychiatric emergency department with symptoms of decreased sleep, elevated mood, flight of ideas, pressured speech, bizarre behavior and grandiosity. Collateral from the family revealed what was suggestive of a recent manic episode six weeks before his current admission. His current symptoms were more severe than those of his previous episode and had been occurring for more than one week and causing significant functional impairment.

Management, Outcome and Follow-up

The patient tested negative on urine drug screen. A brain MRI was ordered to assess for a neurological etiology, but the MRI was normal. The patient’s epilepsy was currently being managed with phenobarbital.. Initially, the patient had limited insight into his mania, but after his second day of admission he agreed to try a mood stabilizer, specifically valproic acid. The patient responded well to the mood stabilizer with a full remission of manic symptoms in approximately one week. The patient was scheduled to follow up with his primary care physician, psychiatrist and neurologist post-discharge.

Final/Working Diagnosis

Epilepsy with Bipolar Disorder Type I

 

References

1. Mazza M, Di Nicola M, Marca GD, Janiri L, Bria P, Mazza S. Bipolar Disorder and Epilepsy: A Bidirectional Relation? Neurobiological Underpinnings, Current Hypotheses, and Future Research Directions. The Neuroscientist. 2007;13(4):392-404. doi:10.1177/10738584070130041101
2. Nishida T, Kudo T, Nakamura F, Yoshimura M, Matsuda K, Yagi K. Postictal mania associated with frontal lobe epilepsy. Epilepsy Behav. 2005 Feb;6(1):102-10. doi: 10.1016/j.yebeh.2004.11.009. PMID: 15652742.
3. Harden CL, Goldstein MA. Mood disorders in patients with epilepsy: epidemiology and management. CNS Drugs. 2002;16(5):291-302. doi: 10.2165/00023210-200216050-00002. PMID: 11994019. 4. Mula M, Schmitz B, Jauch R, Cavanna A, Cantello R, Monaco F, Trimble MR. On the prevalence of bipolar disorder in epilepsy. Epilepsy Behav. 2008 Nov;13(4):658-61. doi: 10.1016/j.yebeh.2008.08.002. Epub 2008 Sep 9. PMID: 18723118.