title: Should a psychotic or manic episode be considered an early manifestation of Multiple Sclerosis? A multiple case study.
abstract: BACKGROUND
  Early manifestations of Multiple Sclerosis (MS) can be atypical and misleading, and several case report studies have highlighted that MS onset sometimes takes the form of a psychotic or manic episode.
  
  
  METHODS
  All neurologists belonging to the French Multiple Sclerosis Observatory network were contacted by email and were asked to find patients with MS who presented with a history of psychiatric episode(s) near MS onset.
  
  
  RESULTS
  Seventeen patients were selected that met the criteria of presenting with psychotic or manic symptoms either before the diagnosis of MS (N=8), or at the time of the first neurological episode or shortly after (N=9). Patients with a history of a psychiatric episode occurring before the first neurological episode were diagnosed on average 7 years later than patients with either a first neurological or a mixed (both neurological and psychiatric) episode. However, psychiatric symptoms in the first group and the first neurological symptoms of MS in the second group occurred at a similar age.
  
  
  CONCLUSIONS
  Based on this multiple case study, we question whether past psychotic or manic episode should be considered equivalent to a first manifestation of MS.
authors.affiliation: Department of Psychiatry, University Hospital of Strasbourg, INSERMU1114, Strasbourg, France; University of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, France. Electronic address: fabrice.berna@chru-strasbourg.fr.
authors.forename: F
authors.initials: F
authors.lastname: Berna
authors.affiliation: University of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, France; Department of Neurology, University Hospital of Strasbourg, Strasbourg, France; Centre Mémoire de Ressources et de Recherche, Hôpitaux Universitaires de Strasbourg, CNRS, Laboratoire ICube, Strasbourg, France.
authors.forename: F
authors.initials: F
authors.lastname: Blanc
authors.affiliation: Department of Neurology, University Hospital of Nice, Hôpital Pasteur, Nice, France.
authors.forename: C
authors.initials: C
authors.lastname: Lebrun
authors.affiliation: Department of Neurology, University Hospital of Nîmes, Hôpital Caremeau, Nîmes, France.
authors.forename: G
authors.initials: G
authors.lastname: Castelnovo
authors.affiliation: Neurologist's Practice, 2 rue Armand Bloch, Montbeliard, France.
authors.forename: C
authors.initials: C
authors.lastname: Clerc
authors.affiliation: Department of Neurology, Central Hospital, Nancy, University of Nancy, School of Public Health, EA-4003, Faculty of Medicine, Vandoeuvre-lès-Nancy, France.
authors.forename: M
authors.initials: M
authors.lastname: Debouverie
authors.affiliation: Department of Psychiatry, University Hospital of Marseille, UMR-7286, Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Jouvenoz
authors.affiliation: Department of Neurology, Hôpital Roger Salengro, Department of Immunology, University of Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Marcel-Viallet
authors.affiliation: Neurologist's Practice, 64 rue Robert Schuman, Colmar, France.
authors.forename: C
authors.initials: C
authors.lastname: Zaenker
authors.affiliation: Department of Neurology, Hôpital Roger Salengro, Department of Immunology, University of Lille, France.
authors.forename: H
authors.initials: H
authors.lastname: Zephir
authors.affiliation: Department of Psychiatry, University Hospital of Strasbourg, INSERMU1114, Strasbourg, France; University of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, France.
authors.forename: P
authors.initials: P
authors.lastname: Vidailhet
authors.affiliation: University of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, France; Department of Neurology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: J
authors.initials: J
authors.lastname: De Sèze
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
keywords: Manic disorder; Multiple Sclerosis; Psychotic disorder