New - Bipolar Questions

Discussion in 'General Parenting' started by BestICan, Jan 25, 2007.

  1. BestICan

    BestICan This community rocks.

    Hi everyone,

    I've been a lurker for long enough to know how supportive you all are, so I thought I'd chime in with a question about this diagnostic quest we're on.

    difficult child is a 7-year-old boy who was diagnosed with partial complex seizures last year. He's always been impulsive, mildly to moderately oppositional, intense, and extremely bright. I've often had to talk to teachers about his unwillingness to sit in circle time or rest quietly at nap time, or shouting out in class when he got to kindergarten, etc. He's often had intense fears, and really has never slept on his own reliably (But Dr. Sears says that's normal...right? Sigh...) So, he's intense and a little offbeat, but always pretty much functioning normally, has friends, etc. He's on Tegretol 100mg 2x daily for the seizures, and his blood level is 4.

    In the past several months, he's been doing things that seem out of character for him. Some pretty scary tantrums (VERY infrequent but scary nonetheless), tormenting his brother (very frequent), exploding with frustration about every little thing. He does very well in school academically, relatively poor behaviorally at school, but nothing more has been needed than chatting with the teacher. Unfortunately, more often than not, life at home is living hell. So much intensity, impulsivity, inability to leave his brother alone, oppositional behavior.

    We don't think he's got ADHD, and we think his seizures are under control, but there was never any findings on the MRI or EEG anyway so I don't know how we can be empirically certain.

    He has a crappy, dismissive neurologist (we're working on changing that). He has a genius therapist. We saw one psychiatrist, without difficult child, just parents, who suspects bipolar but admittedly doesn't know much about seizures.

    Here's what I'm wondering:
    -Does anyone have any experience teasing apart behaviors associated with seizures from bipolar symptoms?
    -Does anyone have any opinion on whether Tegretol is part of the problem, or part of the solution?
    -I'm shaking in my boots after hearing the word "bipolar" and reading a book on the subject that seems rather frightening. Can any reassure me that treating a bipolar child may not be the nightmare of ups/downs/wrong medications that I fear it will be?

    Thanks for listening!
     
  2. Fran

    Fran Former Site Owner

    Hi BestIcan.
    I'm afraid that I can not assure you that there is not a nightmare ahead with behavior changes and extremes in mood. If he is bipolar. This is still a big if. in my humble opinion.
    Get a thorough evaluation by another neurologist. There are those that specialize in epilepsy. Rule out first things first and then move down the list. I certainly wouldn't jump on the opinion of one psychiatrist that never saw the child. I find this almost irresponsible on his part.

    Get the evaluations. If it is bipolar, it's not the end of the world. It just requires the same vigilance as his seizure disorder does. It's not easy and the medication thing is a bit of a roller coaster but you want him to be stable, safe and protected. You want to work to protect this little guy so his disorders do not cause him pain or public embarassment. Medication is the leading method for both disorders.
    Tegretol may or may not be the culprit but that will require someone who knows more than I.
     
  3. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Well...since no one else has jumped in here I will. Welcome to the board.

    I dont know that I can really answer your questions adequately. I have a theory which is just a gut theory of mine that there are two types of bipolar. One is purely chemically based and one is chemically based but has a seizure component. The seizures would have to be so subclinical that they wouldnt show on EEG's. This would be the reason some folks respond better to the neuroleptics and some respond better to lithium.

    Now how to tease out why your son is responding to his environment in the way he is is kind of like detective work. It could be that you have to see what the levels need to be for bipolar for tegretol. I dont know off the top of my head. Normally the levels are higher than for seizures. He may need to try a different seizure medication or a combo. He probably also needs some behavior mod. Have you read the Explosive Child? Many here swear by it.

    Remember this is a marathon and not a sprint.

    Bipolar isnt easy but it can be dealt with.
     
  4. Wiped Out

    Wiped Out Well-Known Member Staff Member

    BestICan,
    Welcome. I'm glad you found us but sorry you had to. The daily grind with a difficult child can certainly be exhausting. I agree he needs to be evaluated. We're here and you are not alone. Hugs.
     
  5. pepperidge

    pepperidge New Member

    Hi,

    I think to some extent you are ahead of the game in that you are not going to fall into the same traps that some of us have re diagnosis's and medications since you already seem to be zeroed in on seizures and possible bipolar. Some of the medication problems some of us have had involve anti-depressants for bipolar type kids, stimulants where they weren't indicated etc. So while there are still alot of medications to try out there, at least you might be starting with a smaller universe. The other piece of good news is that often when you do find a good medication things can improve dramatically.

    At this point I would want to find an really good neurologist but also an extremely good board certified child psychiatrist with a great deal of medication expertise who believes in and has experience dealing with childhood bipolar. You may have to travel some distance to find one--but once you get on a good track then often things can be done locally.

    If you feel comfortable letting us know what part of the country you are in, perhaps people may have some suggestions that they could private message you with.

    On the home front, what kinds of problems are you having? What is your therapist advising? Perhaps people could also give you some suggestions on that front.

    Welcome.
     
  6. smallworld

    smallworld Moderator

    Welcome! I'm glad you decided to come out of hiding.

    There are some seizure disorders (namely temporal lobe epilepsy) whose symptoms mimic bipolar disorder (source: The Bipolar Child by Demitri and Janice Papolos). That's what makes separating out all these dxes all the more difficult. My daughter (difficult child 2) definitely has a mood disorder, but an MRI also revealed small lesions in her temporal lobes, probably as a result of a blood-supply loss in utero. Her neurologist believes these lesions are contributing to her mood disorder. Regardless, he says she is on the right treatment because anticonvulsants (namely Depakote, Lamictal, Tegretol and Trileptal) treat both seizures and mood disorders. Although we're not doctors and can't diagnosis or treat, in my humble opinion, Tegretol would likely be part of the solution rather than part of the problem. As Janet indicated, however, mood disorders typically require higher doses of anticonvulsants for bipolar disorder than are used to treat seizures.

    I would strongly recommend finding a new pediatric neurologist as well as a board-certified child psychiatrist (one who actually evaluates your son in person) to help you sort out what is what and get your difficult child on the right treatment. Because my difficult children have migraines, they see a neurologist every 3 months; for their mood disorders, they see a child psychiatrist weekly for medication management and psychotherapy. The docs work together to make sure my difficult children are getting appropriate treatment. It is only with this kind of concerted effort have we been able to make any progress at all.

    I hope you get some answers soon. Again, welcome.
     
  7. BestICan

    BestICan This community rocks.

    Everyone, thanks so much for your thoughtful responses!

    Fran, thank you for the reality check that I needed. "Not the end of the world"...as silly as this sounds, that's a concept I hadn't actually considered until now.

    Janet, you have a very interesting theory, indeed! I didn't know that the dosage for mood disorders is higher than for seizures. Sheesh, if it would help to just give the guy a higher dose, I can't really see why we have anything to lose by trying. We are definitely using behavior mod techniques - as many parents here probably can identify with, we are definitely WAAAY beyond "parenting 101" stuff that you see in books. Our therapist has been really great in suggesting ways to talk to difficult child that seem to help.

    Sharon, thanks for the hugs! Most definitely needed.

    Pepperidge, thanks for your great ideas and support. I see what you mean about prescribing for the wrong disorder, and how we might be ahead of the curve. That thought is VERY comforting. To answer your questions, we're in Los Angeles and sadly, we have an HMO that stinks with regard to choices in behavioral health practitioners. We've been paying out of pocket for therapy/psychiatric consult because we are working hard to find the best professionals who have been recommended by people we trust. So, heck yeah, I'll take any recommendations this board can give!

    To answer your other question, the biggest most difficult problem is when difficult child will just terrorize easy child for no reason that I can see, other than he's feeling agitated. He'll just look up from his breakfast cereal and growl loudly at him, or see him across the room and start walking toward him with this scary zombie walk, and if they're in the car it's just relentless.

    I know that some amount of sibling teasing is typical, but it's SO SO SO hard hard, sometimes impossible, to redirect him or get him to stop. Also, easy child is only a young 3 while difficult child is 7, so it's especially mean and scary that he's doing this. On good days he acts protective toward his brother but on bad (most) days he doesn't seem to get, or care, that his brother is really terrified by him. One tactic that our therapist has recommended is to stop it from escalating by saying in a kind voice, "I see you're having a really hard time stopping right now. But can you stop anyway?" or to just notice aloud, without judgment, "It's fun for you to scare your brother, huh? Is he enjoying it, too?" But that doesn't seem to work, and I'm sorry, but "mama bear" comes out when someone is threatening my son, even if the one doing the threatening is my other son! So, again, heck yeah, I'll take any advice you can give!

    Nomad, thanks for your input. I'm sorry things are rough with your daughter, and I know how hard it is to deal with impulsivity issues! I'm so glad things are going well with your spouse, and I'll take that advice to heart. I love how you mention that the diagnosis is less important than the solution. Thanks for putting that into perspective.

    All my best to you!

    Jen (forgot to put my name in my siggy - will work on that!)
     
  8. Sara PA

    Sara PA New Member

    My seizure links:

    The Pediatric Neurology Site: Seizures
    http://www.childbrain.com/seizure1.shtml

    MEDLINEplus Medical Encyclopedia: Seizures
    http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm

    Partial (focal) seizure
    http://www.nlm.nih.gov/medlineplus/ency/article/000697.htm

    Medications which may lower seizure threshold
    http://www.australianprescriber.com/magazine/24/1/8/9/#

    Possible Temporal Lobe Symptoms
    http://www.pni.org/neuropsychiatry/seizures/ptls.html

    Temporal lobe lesions
    http://www.patient.co.uk/doctor/Temporal-Lobe-Lesions.htm

    Temporal Lobe Epilepsy
    http://www.patient.co.uk/doctor/Temporal-Lobe-Epilepsy.htm

    Abdominal Epilepsy
    http://www.meridianinstitute.com/abepilep.htm

    Fear as the main feature of epileptic seizures
    http://jnnp.bmjjournals.com/cgi/content/full/70/2/186

    The Merck Manual of Diagnosis and Therapy: Seizure Disorders
    http://www.merckmanuals.com/profess...seizure_disorders.html?qt=epilepsy&sc=&alt=sh


    I would appreciate being notified of any bad links. Thanks.
     
  9. timer lady

    timer lady Queen of Hearts

    Jen,

    I wanted to stop in & welcome you to our little corner of the cyber world.

    Remember that your difficult child is still very young - there's a lot of time & maturity before you'll have the "big" picture of what life will be.

    Take a break for yourself when you can. :smile:
     
  10. Hound dog

    Hound dog Nana's are Beautiful

    Welcome. Glad you decided to come out of lurkdom. :biggrin:

    Do you have a children's hospital near you? Usually their neurology clinics are awfully darn good, with excellent docs.

    I go with getting another complete neuro evaluation done. New doctor, new opinion. Not all neuros are cut from the same cloth. Believe me. Been to more than my fair share. If you don't like the results you're getting from any doctor, your best bet is to always go for a second opinion. Or a third. Or a forth.

    If you decide to seek a new neuro, prepare a parent report with difficult child's medical history, symptoms, behaviors both at home and at school. It's good to list just about anything you can think of cuz you'll never know what might be important. I even offered to bring in video tapes of my oldest difficult child when he was younger to show the neuro. lol Although it turned out not to be necessary.

    in my opinion starting with the possible physical and then moving on works best. The diagnosis process can be a trial within itself. But hang in there. We'll be here. Your lil guy is still young yet. Dxes at his age can sometimes be tough to pin down.

    Hugs
     
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