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Traumatic brain injury causing bipolarism

Date: Wed, 11 Jun 97 19:36:32 EDT
From: David Epstein <dhe@eden.rutgers.edu>
Subject: Traumatic brain injury causing bipolarism

Hartley Alsgaard writes,

Is there evidence that TBI can cause bipolarism?
Yes; it doesn't seem very common, but it happens. Predisposing factors are discussed in:

Starkstein SE, Pearlson GD, Boston J, Robinson RG. Mania after brain injury. A controlled study of causative factors. Archives of Neurology. 44 (10): 1069-73, 1987 Oct.

and is there any suggestion as to choice of medication in cases like this?
Ironically, I just found a paper on this:

Bakchine S, Lacomblez L, Benoit N, Parisot D, Chain F, Lhermitte F. Manic-like state after bilateral orbitofrontal and right temporoparietal injury: efficacy of clonidine. Neurology. 39 (6): 777-81, 1989 Jun:

A manic-like state occurred in a 44-year-old right-handed woman with bilateral orbitofrontal and right temporoparietal traumatic contusions. In a brief trial, we assessed the effect of clonidine, carbamazepine, dopa therapy, and placebo on manic symptoms and cognitive functions. Clonidine rapidly reversed the manic syndrome. The patient's behavior did not change with carbamazepine and worsened with levodopa. We suggest that the manic-like syndrome was related to noradrenergic overactivity secondary to the fronto-orbital lesions.

Date: Wed, 11 Jun 1997 23:17:24 -0400
From: Francis Mas <fmas@mindspring.com>
Subject: Traumatic brain injury causing bipolarism

There is a good literature (mostly Scandinavian and British) on non genetic manic depression. Among others look for:

Dalen P. Family history, the electroencephalogram and perinatal factors in manic conditions. Acta Psychiatrica Scandinavica. 41 (4): 527-63, 1965.

Bracken P. Mania following head injury. British Journal of Psychiatry. 150: 690-2, 1987 May.

Bamrah JS, Johnson J. Bipolar affective disorder following head injury. British Journal of Psychiatry. 158: 117-9, 1991 Jan.

The consensus is that anticonvulsants are the drugs of choice in most of these instances.

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