Mania and Elation

Abstract

Despite the substantial literature on mood disorders in epilepsy, the majority of authors focused on depression with limited data on manic symptoms. Historically, this was due to the general impression that both psychomotor excitation and overt mania were rarely encountered in epilepsy. However, recent studies demonstrated that manic symptoms can be occasionally seen in the context of epilepsy, either as seizure-based phenomena or as treatment-emergent adverse events. This chapter briefly describes the evolution of the concept of bipolar disorders and covers the main symptom clusters usually described in manic episodes. In the epilepsy setting, peri-ictal manic symptoms are described post-ictally and are often associated with psychotic symptoms. Inter-ictal manic symptoms are definitely rare. Specific clinical entities, such as the inter-ictal dysphoric disorder of epilepsy, present some overlaps with the more unstable form of rapid cycling bipolar type II patients, but main psychopathological features are different. Manic symptoms as treatment-emergent adverse events of antiepileptic drugs are anecdotally described as well as after epilepsy surgery. Finally, major treatment options for mania in patients with epilepsy and the use of lithium are discussed.