Overlap of precipitating factors in mania and partial seizures: in pursuit of shared pathophysiology

Aims: Comparisons of aetiological factors may cast light on brain regions and processes through which disorders develop. A standard classification of aetiology considers predisposing, precipitating and perpetuating factors. Precipitating factors, proximate to illness episodes, prompt the change from vulnerability to frank illness. Comparison of precipitants has been studied for epilepsy and migraine. Similarities recommending this approach for mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes include: chronic course punctuated by acute episodes; sensory, perceptual, cognitive and affective symptoms; response to anticonvulsants. Common mechanisms inferred include neurotransmitters and kindling. Investigations comparing mania and PS may highlight relevance of temporal lobe mediated processes and pathology. This study compares precipitating factors of manic episodes, and of PS in diagnosed epilepsy to identify the extent and nature of their overlap.

Methods: Review based on literature search of PubMed and Google Scholar.

Results: Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone goal-attainment events, spring and summer season, postpartum, and drugs including steroids and stimulants. For PS alone winter season, menstruation and specific triggers in complex reflex epilepsies.

Conclusions: The overlap of precipitating factors in mania and PS imply common brain processes may contribute to both.