Q:  Lithium & Temporal Lobe Seizures

My son was just recently diagnosed as bi-polar II, he has some definate neuro symptoms, while having extreeme irritation his left eye drops, after this happens he is either ravenously hungry specifically for carbohydrate foods, or want to sleep and does for serveral hour. We have had a neurologist see him, and he produced the seft eye droop when he had my son hyperventilate, we had an EEg and MRI which came back negative for temporal lobe seizures. My son refused to hyperventilate while having the EEG. The psychiatrist want to start my son on either depekote or lithium. I still have some doubt as to if this might be a seizure. If I decided to have him start the lithium, would this hinder still looking in to the temporal lobe seizures.  Would the medication decrease temporal lobe seizures. I understand the depekote would.

Thanks
Janice


Dear Janice -- 
Lithium is associated with "lowering the seizure threshold", that is, making it easier for someone who has a tendency toward having seizures to actually have one.^Lee  However, I had to search quite a while to find some evidence backing up this assertion, and it is not a medication that we routinely recognize as a problem for someone with seizure disorder, e.g. compared to the old "tricyclic" antidepressants, so my sense is that lithium is somewhat less likely to cause a seizure in someone like your son compared to antidepressants and some members of the antipsychotic family, which we also use in bipolar disorder, even in Bipolar II at times.  

Therefore, starting lithium would not seem to interfere with the diagnostic effort underway regarding temporal lobe epilepsy.  If that's the correct diagnosis, it's also less likely the lithium would help, of course.  Here's an interesting article you might want to dig up on the subject of temporal lobe epilepsy; your local librarian could help you get a copy);  judging from the abstract (take that link), the 10 cases described might be worth reading through to compare to what you see in your son.  Granted, the emphasis is on psychosis, which is by definition not "bipolar II".  However, you might find that the details of how their patients' symptoms showed up could teach you something. 

I find the first sentence in your description very suggestive of epilepsy compared to (or in addition to) bipolar disorder, and also likely indicative of how much you've already learned about distinguishing a seizure condition from something like bipolar disorder.  Good luck getting this figured out.  Note, of course, that after a while the diagnosis (e.g. is it bipolar or epilepsy?) becomes somewhat moot as you prepare to try anticonvulsant medications that can treat both. 

Dr. Phelps

Published May, 2004