title: Clinical experience with anticonvulsant medication in pediatric epilepsy and comorbid bipolar spectrum disorder.
abstract: Anticonvulsant drugs are first-line treatments for both bipolar mood disorder and epilepsy; however, few studies have explored treatment options when these disorders co-occur. The aim of this study was to identify bipolar disorder symptoms common in pediatric epilepsy and to determine whether anticonvulsant monotherapy might be a practical treatment consideration. A retrospective chart review identified 38 children with bipolar spectrum disorder and epilepsy comorbidity. Two mental health clinicians independently assessed psychiatric diagnoses, symptoms, and assigned retrospective CGI-I ratings for psychiatric symptoms. Common bipolar symptoms included impulsivity, psychomotor agitation, and explosive rage. Forty-two medication trials with 11 different anticonvulsants were identified. Of the 30 instances in which anticonvulsant monotherapy was attempted, carbamazepine, divalproex sodium, lamotrigine, and oxcarbazepine were associated with better psychiatric CGI-I ratings than other monotherapies (P<0.01). Results suggest that in many cases, selected anticonvulsants appeared to simultaneously treat both epilepsy and mood disorder. Controlled trials are necessary to further ascertain optimal anticonvulsant usage.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC, USA. jsalpeka@cnmc.org
authors.forename: Jay A
authors.initials: JA
authors.lastname: Salpekar
authors.forename: Joan A
authors.initials: JA
authors.lastname: Conry
authors.forename: Wright
authors.initials: W
authors.lastname: Doss
authors.forename: Sandra
authors.initials: S
authors.lastname: Cushner-Weinstein
authors.forename: Phillip L
authors.initials: PL
authors.lastname: Pearl
authors.forename: Steven L
authors.initials: SL
authors.lastname: Weinstein
authors.forename: William D
authors.initials: WD
authors.lastname: Gaillard
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D002648:Child; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D000927:Anticonvulsants