Bipolar disorder and multiple sclerosis: a case series.
BACKGROUND
The prevalence of psychiatric disturbance for patients with multiple sclerosis (MS) is higher than that observed in other chronic health conditions. We report three cases of MS and bipolar disorder and we discuss the possible etiological hypothesis and treatment options.


METHODS
All patients fulfilled the McDonald criteria for MS. Two patients were followed up in psychiatry for manic or depressive symptoms before developing MS. A third patient was diagnosed with MS and developed deferred psychotic symptoms. Some clinical and radiological features are highlighted in our patients: one manic episode induced by high dose corticosteroids and one case of a new orbitofrontal MRI lesion concomitant with the emergence of psychiatric symptoms. All patients needed antipsychotic treatment with almost good tolerance for high dose corticosteroids and interferon beta treatment.


CONCLUSIONS
MRI lesions suggest the possible implication of local MS-related brain damage in development of pure "psychiatric fits" in MS. Genetic susceptibility is another hypothesis for this association. We have noticed that interferon beta treatments were well tolerated while high dose corticosteroids may induce manic fits.
Department of Neurology, Razi Hospital, Manouba, 2010 Tunis, Tunisia.
Youssef
Y
Sidhom
Department of Neurology, Razi Hospital, Manouba, 2010 Tunis, Tunisia.
Mouna
M
Ben Djebara
Department of Neurology, Razi Hospital, Manouba, 2010 Tunis, Tunisia.
Yosr
Y
Hizem
Department of Neurology, Razi Hospital, Manouba, 2010 Tunis, Tunisia.
Istabrak
I
Abdelkefi
Department of Neurology, Razi Hospital, Manouba, 2010 Tunis, Tunisia.
Imen
I
Kacem
Department of Neurology, Razi Hospital, Manouba, 2010 Tunis, Tunisia.
Amina
A
Gargouri
Department of Neurology, Razi Hospital, Manouba, 2010 Tunis, Tunisia.
Riadh
R
Gouider
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult
D014150:Antipsychotic Agents