Bipolar affective disorder prior to the onset of multiple sclerosis

The frequent association of affective disorder and multiple sclerosis raises important aetiological and clinical considerations. Reported here are seven patients who presented with symptoms of multiple sclerosis and who had a preceding history of bipolar affective disorder. The hypothesis that bipolar illness may be the initial manifestation of multiple sclerosis is discussed with reference to relevant clinical and epidemiological research on the topic.