Differences in course of illness between patients with bipolar II disorder with and without epileptiform discharges or other sharp activity on electroencephalograms: a cross-sectional study

O K Drange, S G Sæther, P I Finseth, G Morken, A E Vaaler, V Arntsen, O Henning, O A Andreassen, T Elvsåshagen, U F Malt, E Bøen, O K Drange, S G Sæther, P I Finseth, G Morken, A E Vaaler, V Arntsen, O Henning, O A Andreassen, T Elvsåshagen, U F Malt, E Bøen

Abstract

Background: A diagnosis of bipolar II disorder requires that the symptoms cannot be better explained by a medical condition. Epilepsy is in some cases associated with an affective syndrome mimicking an unstable bipolar II disorder. Epileptiform discharges on electroencephalograms (EEGs) are typical, but not pathognomonic, for epilepsy. A previous study has found a high frequency of epileptiform discharges and other sharp activity among patients with bipolar disorder. The aim of the study was to identify if epileptic discharges or other sharp activity per se are associated with an altered course of illness among patients with bipolar II disorder.

Methods: Eighty six patients diagnosed with bipolar II disorder at two psychiatric departments were interviewed about prior course of illness and assessed with EEGs. The patients were split into two groups based on the presence (n = 12) or absence (n = 74) of epileptiform discharges or other sharp activity. Wilcoxon rank sum test, Fisher's exact test, and Pearson's chi squared test were used to assess differences between the groups on six variables of course of illness.

Results: Patients with epileptiform discharges or other sharp activity had a history of more hypomanic episodes per year (median (interquartile range (IQR)) 1.5 (3.2) vs. 0.61 (1.1), p = 0.0090) and a higher hypomania:depression ratio (median (IQR) 3.2 (16) vs. 1.0 (1.0), p = 0.00091) as compared to patients without. None of the patients with epileptiform discharges or other sharp activity had self-reported epileptic seizures in their history.

Conclusions: Epileptiform discharges or other sharp activity on EEGs are associated with more hypomanic episodes and an increased hypomania:depression ratio. Our results warrant replication in prospective studies, but suggest that EEG findings could be of prognostic importance for patients diagnosed with bipolar II disorder in psychiatric care.

Trial registration: ClinicalTrials.gov ( NCT00201526 ).

Keywords: Bipolar disorder; Electroencephalography; Epileptiform discharges; Sharp activity.

Conflict of interest statement

OKD, SGS, PIF, GM, AEV, VA, and UFM declare that they have no competing interests. OAA has received speaker’s fees from Lundbeck, and is a consultant to HealthLytix. OH has received speaker’s fees from UCB, Livanova, and Eisai. TE has received speaker’s fees from Lundbeck and Janssen Cilag. EB has received speaker’s fees from Lundbeck.

Figures

Fig. 1
Fig. 1
Frequency and ratio of depressive and hypomanic episodes among patients with and without epileptiform discharges or other sharp activity. Data are presented as violin plots with individual level data points at logarithmic y-axes. A small horizontal and vertical jitter is added to better discriminate overlying data points

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