Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

- Bipolar disorder (BD) and partial seizures (PS) arising from the temporal lobes are both chronic disorders with episodic manifestations.
- Shared precipitating factors common to mania and PS include stress, sleep reduction and antidepressant medication and more tentatively intense emotion.
- Precipitating factors that pertained only to episodes of mania included goal-attainment events, spring and summer months and the postpartum period.
- Precipitating factors that pertained only to PS arising from the temporal lobes included winter and menstruation.
- The overlap of precipitating factors in the two suggests that common mechanisms underlie the disorders although there are many individual differences as demonstrated by case reports.

ObjectivesMania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap.MethodNarrative review based on a literature search of PubMed and Google Scholar.ResultsPrecipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures.ConclusionsThe overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research.