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Rapid cycling in severely multidisabled children: a form of bipolar affective disorder?
J E Jan1, I F Abroms, R D Freeman
1Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Insights
This study describes a rare, recurring biphasic disorder in severely disabled children resembling rapid cycling bipolar illness. While melatonin helped sleep, it did not eliminate the cyclical mood and energy shifts.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Neurodevelopmental Disorders
Background:
- Describes a unique, regularly recurring biphasic disorder in six severely multidisabled children.
- The disorder presented with alternating states of lethargy/hypersomnolence and high-energy/hyperactivity over several days.
Observation:
- Children experienced significant changes in mood, energy levels, sleep patterns, and cognitive/motor abilities during cyclic episodes.
- Episodes persisted for years in most cases, with one child experiencing spontaneous remission.
Findings:
- Despite extensive investigations (neurologic, metabolic, endocrine), the etiology remained unknown.
- Family histories revealed a prevalence of affective disorders.
- Melatonin regulated sleep but did not resolve the core cyclical symptoms. Other treatments (antiepileptics, lithium, sedatives, stimulants, tranquilizers, light therapy) were largely ineffective.
Implications:
- The observed symptoms align with modified diagnostic criteria for bipolar affective illness in neurologically disabled patients.
- This suggests a potential variant of rapid cycling affective disorder in severely multidisabled children.
- Further research is needed to understand the etiology and develop targeted treatments for this unique pediatric disorder.
Abstract:
A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled children. It was characterized by several days of lethargy, withdrawal, loss of abilities, irritability, and hypersomnolence followed or preceded by a high-energy state for several days during which the children slept very little, at times were euphoric, had improved mental ability, and were hyperactive. These cyclic episodes had been present for years but unexpectedly disappeared in one child. The etiology is unknown, in spite of detailed neurologic, metabolic, and endocrine investigations. All patients had family histories positive for affective disorder. Melatonin treatment helped to regulate the coexisting chronic sleep disorders of 3 children but failed to eliminate the cycles. Antiepileptic drug treatment, lithium, sedatives, stimulants, tranquilizers, and light therapy were largely ineffective. The children's symptoms and signs fit the diagnostic criteria of a bipolar affective illness, as it was modified for patients with associated neurologic disability; therefore, the patients appeared to have a unique disorder that closely resembles or is a variant of rapid cycling affective disorder.