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In recent studies it is pointed out that manic or hypomanic symptoms are not rare in epilepsy. In a study revealed that 11.8% of 143 adult outpatients with epilepsy had DSM-based diagnosis of BD, but only 2 patients (1.4%) of whom could be considered as having ‘‘pure BD”, when excluded BD symptoms such as interictal dysphoric disorder of epilepsy, postictal manic or hypomanic states, and preictal dysphoria. There are similarities between epilepsy and BD with regard to both of them are episodic end chronic. In addition, antiepileptic drugs are used in treatment of both two disorders. While in 30% of epilepsy patients, a drug-resistant course of the illness develops, 40% of bipolar patients do not respond sufficiently to lithium and need alternative treatments. Although ECT is used in BD rarely, ECT remains as an important option for resistant patients. For acut mania, two prospective-controlled studies have compared ECT to lithium and lithium+haloperidol and in both two studies ECT was found more effective than medical treatment. According to a review ECT is associated with remission or marked clinical improvement in 80% of those treated.
Case: A 28 year-old female patient was brought to our clinic with complaints of irritability, talking too much, insomnia, thinking of an important one and people talk about herself on television, auditory hallucinations and consequently delusions of reference, persecutory and erotomanic. It is learned despite of her regular treatment (valproatee, paliperidone and quetiapine), she had manic episodes almost every year and residual manic symptoms continued in intervals of episodes. Valproatee used as a mood stabilizer was stopped because of not seen effectively and lithium 900 mg and 1200 mg quetiapine was started for manic syndromes. Due to unresponsiveness to the treatment aripiprazole and haloperidol were added and respectively upgraded 30mg and 20 mg. Nevertheless, effective response could not occurred for 5 weeks with oral therapy. For this reason, electroconvulsive therapy (ECT) was planned for the patient. After seven sessions of ECT, the symptoms markedly reduced. We decided to stop ECT and the drug therapy of patient was arranged as lithium 1200 mg, quetiapine 1200 mg, haloperidol 20 mg, risperidone 8mg. But one week later, due to recurrence of manic symptoms, three sessions of ECT were performed to the patient again. The patient with highly resistant antipsychotics and mood stabilizers was kept under observation for one more week, after complete remission related with the total of ten sessions of ECT. Then her maintenance therapy was prescribed and she was discharged proposed frequent follow-up. In our case, valproatee also an antiepileptic and lithium very effective mood stabilizer in mania were found failed. In addition the patient was resistant to typical and atypical antipsychotics such as haloperidol, quetiapine and aripiprazole. Previously, a case of drug-resistant and ECT-responded BD mania comorbid with epilepsy was not reported in the literature, in this context we think that discussed above the case is important.