Abstracts

Anticonvulsant drugs are commonly used as first line treatments for both bipolar mood disorders and epilepsy. We sought to identify medications commonly used in pediatric epilepsy patients with comorbid bipolar disorder or explosive mood symptoms, and assess whether single drug therapy was effectively used in treatment of both conditions. A retrospective chart review was conducted in a tertiary care pediatric facility. Records sufficient to confirm diagnoses of mood disorder and epilepsy, and to assess treatment responses were included. Psychiatric diagnoses, symptoms, and treatment responses were rated independently by two mental health clinicians, one of whom was a board certified child psychiatrist. A board certified child neurologist specializing in epileptology confirmed epilepsy diagnoses and treatment ratings. Divalproex sodium and lamotrigine were highlighted by virtue of having FDA indications for treatment of partial seizures in adults and children, and for bipolar disorder in adults. Clinical improvement was noted if Clinical Global Impression Improvement (CGI-I) ratings were 1, 2, or 3 (1-7 scale). Thirty-eight (21 male, average age 10.4) patients were selected. Thirty had complex partial seizure disorder and eight had primary generalized seizure disorder. Half met DSM-IV criteria for Bipolar I Disorder; the other half had nonspecific mood disorder that included altered mood states but insufficient criteria for a Bipolar I diagnosis. Common mood disorder symptoms included impulsivity (37), psychomotor agitation (37), and explosive rage (28). Forty-two medication treatment trials with 11 different anticonvulsants were identified and rated. CGI-I ratings for seizure control did not significantly differ between drugs. Monotherapy was attempted in 30 instances. In the 20 cases where lamotrigine, divalproex sodium, or carabamazepine were used, CGI-I ratings for psychiatric symptoms were better than for the other 10 cases (p=0.03). Use of divalproex sodium (15) or lamotrigine (6) either in single or combination treatment was associated with psychiatric improvement (p=0.016). Divalproex sodium used either as monotherapy or adjunctive therapy was associated with greater clinical improvement as compared to all other medications (p=0.03). In children with epilepsy and bipolar mood disorder symptoms, use of anticonvulsants with adult bipolar FDA indications were associated with greater psychiatric improvement with no apparent difference in seizure control. Divalproex sodium, either as monotherapy or as adjunctive therapy was associated with greater psychiatric improvement as compared with other medications. In some cases, single anticonvulsants appeared to simultaneously treat both epilepsy and mood disorder symptoms. (Supported by Grant: Abbott Laboratories, Inc.)