Prevalence of bipolar symptoms in

epilepsy vs other chronic health disorders

Alan B. Ettinger, MD; Michael L. Reed, PhD; Joseph F. Goldberg, MD; and Robert M.A. Hirschfeld, MD

Abstract—Objective: To estimate the comparative prevalence of bipolar symptoms in respondents with epilepsy vs other
chronic medical conditions. Methods: The Mood Disorder Questionnaire (MDQ), a validated screening instrument for
bipolar I and II symptoms, in conjunction with questions about current health problems, was sent to a sample of 127,800
people selected to represent the US adult population on selected demographic variables. A total of 85,358 subjects (66.8%)
aged 18 or older returned the survey and had usable data. Subjects who identified themselves as having epilepsy were
compared to those with migraine, asthma, diabetes mellitus, or a healthy comparison group with regard to relative
lifetime prevalence rates of bipolar symptoms and past clinical diagnoses of an affective disorder. Results: Bipolar
symptoms, evident in 12.2% of epilepsy patients, were 1.6 to 2.2 times more common in subjects with epilepsy than with
migraine, asthma, or diabetes mellitus, and 6.6 times more likely to occur than in the healthy comparison group. A total of
49.7% of patients with epilepsy who screened positive for bipolar symptoms were diagnosed with bipolar disorder by a
physician, nearly twice the rate seen in other disorders. However, 26.3% of MDQ positive epilepsy subjects carried a
diagnosis of unipolar depression, and 25.8% had neither a uni- nor bipolar depression diagnosis. Conclusion: Bipolar
symptoms occurred in 12% of community-based epilepsy patients, and at a rate higher than in other medical disorders.
One quarter were unrecognized.
NEUROLOGY 2005;65:535–540

Medical comorbidities are common in patients with
bipolar disorder,1 especially with regard to CNS dis-
orders such as migraine2 or head trauma.3 Sporadic
reports suggest that bipolar disorder may also occur
with higher frequency in epilepsy.4
Treatments for depression in bipolar vs unipolar
patients differ sharply, inasmuch as standard anti-
depressants may destabilize mood by precipitating
mania or accelerating cycle frequency for 25 to 40%
of individuals with a diathesis for bipolar disorder.5
While estimates of depression in epilepsy are as high
as 50% in tertiary epilepsy center-based series,6 and
37% in community-based studies,7 information about
rates of bipolar symptoms in epilepsy have been lim-
ited. Distinguishing bipolar symptoms from depres-
sion is also crucial in epilepsy, since activating
mania with the use of antidepressants may occur.
Further, clinicians may want to select an antiepilep-
tic drug that not only treats seizures but also ad-
dresses mood instability in such patients.
We utilized the recently developed Mood Disor-
Additional material related to this article can be found on the Neurology
Web site. Go to www.neurology.org and scroll down the Table of Con-
tents for the August 23 issue to find the title link for this article.
ders Questionnaire (MDQ) to identify the prevalence
of bipolar symptoms in a community-based sample of
US adults identified as having epilepsy, with com-
parisons made to several other chronic conditions.
We also sought to compare the extent to which previ-
ous misdiagnoses of unipolar depression among bipo-
lar screen-positive subjects differed among survey
respondents with epilepsy as compared to migraine,
asthma, or diabetes mellitus.
Methods. Sample. Detailed methods are provided elsewhere8
and briefly summarized here. Subjects for this study were sam-
pled from the list of nationwide households maintained by Na-
tional Family Opinion Inc. (NFO), a market research firm that
maintains a panel of over 600,000 US households for marketing
and survey purposes. The NFO household panel has previously
been used to determine the general population prevalence of sev-
eral health problems, including migraine9 and bipolar disorder.8
Potential households are initially selected for the NFO panel as
part of a stratified probability sample constructed to be represen-
tative of the US population. Selected households are recruited by
volunteer response to an initial mailing, with demographic infor-
mation obtained from a second mailing to households agreeing to
participate in the panel.
Survey samples are selected from the full panel of households
using a balancing system that provides a sample that matches
demographic characteristics of the US population based on the
2000 US Census data (Census Bureau Resident Population Esti-

From the Department of Neurology (Dr. Ettinger), Long Island Jewish Medical Center, New Hyde Park, NY; Vedanta Research (Dr. Reed), Chapel Hill, NC;
Bipolar Disorders Research Program (Dr. Goldberg), Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore Long Island Jewish
Health System, Glen Oaks, NY; and Department of Psychiatry & Behavioral Sciences (Dr. Hirschfeld), University of Texas Medical Branch, Galveston.
Disclosure: The Epilepsy Impact Project was supported by GlaxoSmithKline, Inc. (GSK). Dr. Ettinger has received honoraria from GSK. Drs. Reed, Goldberg,
and Hirschfeld have received honoraria from GSK in excess of $10,000. Dr. Goldberg has also participated in an advisory board sponsored by GSK. The
epilepsy division at Long Island Jewish Medical Center has received grants in excess of $10,000 from GSK for studies of lamotrigine, which were unrelated
to the current manuscript.
Received January 25, 2005. Accepted in final form May 6, 2005.
Address correspondence and reprint requests to Dr. Alan B. Ettinger, EEG Lab, Long Island Jewish Medical Center, 270-05 76th Ave., New Hyde Park, NY
11040; e-mail: aettinge@lij.edu

Copyright © 2005 by AAN Enterprises, Inc. 535

mates of the United States through November 1, 2000). Household
demographics are updated every 2 years.
Survey procedures. A survey was mailed to heads of house-
holds from 100,000 demographically representative US house-
holds, with a supplemental mailing of 27,800 individuals selected
to improve the representativeness of the total sample for match-
ing adults (18 years of age or older) in the US population. The
sample was balanced to match census data for US households
with respect to age, sex, household size and income, population
density (urban vs rural), and geographic census region. The
household survey was addressed to the NFO member in each
household or their spouse (if applicable) to create a proper male-
female balance. The individual-based sample was sent to specific
household members selected to balance the sample and represent
non-heads of household. Sixty percent of the surveys were tar-
geted toward men and 40% toward women to offset a female bias
in the NFO panel membership. Both the household and individual
based surveys were mailed in January 2001.
Measures. The survey included the Mood Disorder Question-
naire (MDQ), a validated self-report instrument that screens for
the presence of a lifetime history of bipolar disorder.10 The ques-
tionnaire consists of 13 yes/no items (for item list see table E-2,
available on the Neurology Web site at www.neurology.org) de-
rived from both Diagnostic and Statistical Manual of Mental Dis-
orders (DSM-IV) criteria and clinical experience. Additional
questions ask whether symptoms ever co-occurred during the
same period of time (yes/no), and about the degree of functional
impairment caused by the symptoms (four point scale from no
problem to serious problem). An individual is scored positive for
bipolar if 7 or more of the 13 symptom items, plus the co-
occurrence item, are endorsed and a moderate or serious degree of
functional impairment is reported. The MDQ has been validated
in a psychiatric outpatient setting (sensitivity 0.73 and specificity
0.90)10 and in the general US population (sensitivity 0.28 and
specificity 0.97)11 against a diagnosis of bipolar I and II based on
Structured Clinical Interview for DSM-IV12 and recently shown to
have utility in primary care clinics comprised of patients with
diverse medical disorders.13,14
In addition, subjects were asked whether “a health profes-
sional ever told you that you have (check all that apply)” alcohol or
drug use problems, allergies, asthma, bipolar disorder, depression,
diabetes, emphysema or chronic obstructive pulmonary disease
(COPD), epilepsy, hypertension, manic depression, migraine, or
seizure disorder. A final question asked whether “any of your
blood relations (i.e., children, siblings, parents, grandparents,
aunts, uncles) had manic-depression or bipolar disorder.”
Statistical analysis. To correct for minor sampling bias in
returned surveys toward older, female respondents, survey data
were post-weighted to match 2000 US Census15 data in terms of
age, sex, household income, household size, population demo-
graphics, and geographic region.
The comparisons of primary importance in this analysis are
between epilepsy subjects and the other disease and comparison
group subjects. We elected to analyze patients with migraine to
enable analysis of another episodic CNS disorder, and two other
common medical disorders, asthma and diabetes. Multiple health
problems were common in the epilepsy group as well as the other
disease groups (23% of the sample reported two or more of the
pre-listed comorbid health problems). The analysis was conducted
in two ways: 1) using pure groups of individuals reporting only the
health problem of interest and 2) accepting all individuals report-
ing a given health problem. The first approach enables more rig-
orous statistical testing (because the groups are mutually
exclusive), but by removing individuals with more than a single
health problem, the resulting study groups do not reflect the de-
mographic characteristics of that group in the general population.
Disease group definitions using the second approach, which allows
for multiple health problems, more closely matches their natural
distribution in the community but does not allow for statistical
analysis between groups (due to overlapping group membership).
A combined approach was ultimately used. All subjects report-
ing a prior “diagnosis” of epilepsy or seizure disorder were placed
in the epilepsy group. For the migraine, asthma, and diabetes
groups, the small number of epilepsy cases in each group (n ⫽ 338
for migraine, n ⫽ 265 for asthma, and n ⫽ 265 for diabetes) were
removed to keep these groups independent of the epilepsy group.
The comparison group included all other subjects except those
536 NEUROLOGY 65 August (2 of 2) 2005
Figure 1. The percent of subjects screening positive for bi-
polar symptoms in each study group.
reporting epilepsy, migraine, asthma, or diabetes, as well as those
reporting bipolar disorder, manic depression, or depression. This
approach yielded results that were comparable to the pure and
overlapping group definitions but also maintained the true demo-
graphic character of each group. It also enabled statistical testing
between the epilepsy group and the other disease and comparison
groups.
␹2 testing was used to compare epilepsy subjects with mi-
graine, asthma, diabetes, and the comparison group. OR and 95%
CI were calculated for group comparisons, controlling for sample
demographics. Logistic regression modeling was used to measure
the degree of association between demographic and family history
variables and scoring above minimal MDQ threshold criteria for a
likely bipolar disorder.
To address the possibility that epilepsy patients may have
inappropriately endorsed some MDQ queries in reference to peri-
ictal symptoms rather than chronic interictal feelings, we per-
formed a separate analysis examining the mean number of MDQ
positive items as well as the percent of MDQ positivity of each
group after eliminating scores for items that could overlap with
peri-ictal symptoms. These specific MDQ items included “feeling
irritable,” “thoughts raced through the head,” “distracted by
things around you,” or “did unusual things.” For this analysis
these four items were eliminated and a positive case was deter-
mined by endorsing seven (out of nine remaining) symptoms as
well as co-occurrence and moderate to severe functional impair-
ment.
All statistical analyses were performed using WesVar (version
4.1; Westat, Rockville, MD) statistical software designed to accom-
modate complex probability samples and weighted data.
Results. Survey return rates and demographic character-
istics. Nearly 72% (71,836) of the household question-
naires were returned within 6 weeks and 65% (17,973) of
questionnaires from the individual based sample were re-
turned within 5 weeks. Some questionnaires were ex-
cluded as unusable because they were missing age or sex
data or the respondent was under 18 years of age. The
final data set included 85,358 (67% of the sample universe)
usable surveys for analysis. The sample consisted of 1,236
epilepsy, 8,994 migraine, 7,951 asthma, 7,342 diabetes,
and 57,172 comparison subjects. The demographic charac-
teristics and geographic distribution for each study group
are provided in table E-1.
Frequency of bipolar symptoms and lifetime mania
symptoms. Figure 1 provides the frequency of subjects in
each group who screened positive for bipolar symptoms.
Bipolar symptoms were 1.6 to 2.2 times more likely to
occur in the epilepsy group vs the other disease groups,
and 6.6 times more likely than in comparison subjects (p ⬍
0.006 less for all contrasts; table). Nearly all of the individ-
ual symptoms of mania or hypomania occurred more often
in epilepsy subjects vs the other disease and comparison
groups (see table E-2).
Table Comparison of the positive bipolar screen rates of epilepsy
subjects with other study groups
Comparing epilepsy Lower Upper
subjects with: OR 95% CI 95% CI p Value
Migraine 1.55 1.140 2.095 0.006
Asthma 1.87 1.414 2.474 0.000
Diabetes 2.17 1.529 3.072 0.000
Healthy comparison 6.62 4.858 9.032 0.000
group
ORs and 95% CIs are adjusted for demographics.
Detecting bipolar symptoms among epilepsy pa-
tients. Nearly half of the epilepsy subjects with a positive
screen for bipolar symptoms (47.9%) reported having a
prior formal diagnosis of bipolar disorder. This number
was nearly twice that seen in the other disease and control
groups (figure 2); however, a quarter (26.3%) of the epi-
lepsy group carried a diagnosis of unipolar depression only
and the balance (25.8%) were not diagnosed with either
bipolar or unipolar depression. This pattern of bipolar di-
agnosis and unipolar depression non-identification was dif-
ferent for epilepsy vs the other disease groups (p ⫽ 0.017
or less for all comparisons).
Predictors of bipolar symptoms. The results of the lo-
gistic regression analyses predicting positive bipolar
screens found that age (being younger; p ⬍ 0.001 for all)
and sex (being male; p ⬍ 0.030 for epilepsy, p ⬍ 0.001 for
asthma, p ⬍ 0.015 for migraine) were both significant for
all disease groups except diabetes (p ⬍ 0.115), where no
difference was seen for sex. Family history of bipolar disor-
der was a significant (p ⬍ 0.05 or less for all) predictor of a
positive screen within all study groups. Family history of
bipolar disorder occurred in epilepsy 20.6%, migraine
19.9%, asthma 15.5%, diabetes 11.1%, and healthy com-
parison group 8.3%. Statistical testing results were as fol-
lows: for the epilepsy group vs migraine (␹ ⫽ 0.134;
p ⫽ 0.714), vs asthma (␹ ⫽ 8.105, p ⫽ 0.004), vs diabetes
(␹ ⫽ 31.856, p ⬍ 0.000) and vs the healthy comparison
group (␹ ⫽ 49.258, p ⬍ 0.000).
Figure 2. Among subjects screening positive for bipolar
symptoms, the percent reporting a diagnosis of bipolar
disorder (white bar), a diagnosis of unipolar depression
only (light gray bar), and those reporting neither diag-
nosis (dark gray bar). ␹2 testing for epilepsy vs migraine
(p ⫽ 0.017), vs asthma (p ⫽ 0.002), and vs diabetes
(p ⫽ 0.002).
Analysis removing symptoms that could be peri-
ictal. The percentage of subjects by group who continued
to score positive for bipolar symptoms, after removal of the
four items that could be inappropriately endorsed in refer-
ence to peri-ictal symptomatology, were epilepsy 5.15%,
migraine 3.2%, asthma 2.69%, diabetes 1.23%, and healthy
comparison group 0.69%. Statistical testing results were as
follows: for the epilepsy group vs migraine (␹ ⫽ 2.72, p ⫽
0.099), vs asthma (␹ ⫽ 5.28; p ⫽ 0.022), vs diabetes (␹ ⫽
14.24; p ⫽ 0.000), and vs the healthy comparison group
(␹ ⫽ 16.48; p ⫽ 0.000).
Discussion. The present findings are consistent
with previous reports suggesting elevated rates of
comorbidity between bipolar symptoms and a num-
ber of chronic medical conditions. The current obser-
vations are notable for a more robust association
between bipolar symptoms and epilepsy than mi-
graine, asthma, or diabetes mellitus.
Our study is also notable for providing the first
systematic assessment of bipolar symptoms in
community-based epilepsy patients. Prior investiga-
tions in this area have instead focused more exten-
sively on the presence of depression and anxiety
among epilepsy patients,16 or on the emergence of
secondary manias following head trauma or (pre-
dominantly right-sided) brain lesions (e.g., neoplasm
or stroke).17
While a number of studies have noted elevated
rates of specific medical conditions such as diabetes
mellitus18 or migraine,2 as a comorbidity of bipolar dis-
order, our study examined the frequency of bipolar
symptoms among multiple distinct medical diseases.
We found substantial rates of bipolar symptoms in
all conditions studied, especially epilepsy, but also
migraine, asthma, and diabetes. In fact, the rates we
determined may be an underestimate given that the
MDQ has relatively low sensitivity to preserve its
high specificity,11 suggesting that even more patients
may have these symptoms. In non-community, med-
ical center-based populations, psychiatric comorbid-
ity tends to be higher than among community-based
patients; therefore, rates of bipolar symptoms are
also likely to be higher in the former group. This
information is particularly important for any clini-
cian caring for patients with one or more of these
medical conditions, since as has been demonstrated for
unipolar depression,7 if clinicians fail to screen for bipo-
lar disorder, it may go unrecognized and undertreated.
Many neurologists and even epilepsy specialists
may be surprised by the high rates of bipolar symp-
toms in epilepsy, and its significantly higher rates
compared to the other studied disorders. Explana-
tions for the disparity between anecdotal experience
and these findings include the low probability that
most clinicians are screening for bipolar disorder,
physician awareness of psychiatric symptoms but
failure to attribute significance to them, the failure
of some bipolar patients to recognize their symptoms
as being pathologic, or patients’ disinclination to
raise these issues when the typical focus of an office
August (2 of 2) 2005 NEUROLOGY 65 537
visit is upon seizure control. Alternatively, some of
the commonly administered antiepileptic drugs such
as lamotrigine may treat bipolar symptoms19 and
thereby mask this disorder.
Another possibility is that the MDQ is capturing
symptoms associated with the controversial interic-
tal dysphoric disorder (IDD), which some have ar-
gued is a unique dysthymic syndrome commonly
encountered in epilepsy.20 It is said to be character-
ized by fluctuating dysthymia, irritability, alterna-
tion with occasional euphoric periods, fear, anxiety,
anergia, pain, and insomnia. While an overlap with
this controversial syndrome may have explained
some MDQ positive cases, it is notable that nearly
50% of patients with positive MDQ scores carried a
prior diagnosis of bipolar disorder. Future studies
utilizing structured interviews would be helpful to
elucidate whether epilepsy patients meet formal cri-
teria for bipolar disorder or are meeting MDQ crite-
ria on the basis of IDD.
Manic states have also been sporadically de-
scribed during ictal or peri-ictal states.21 The preva-
lence of peri-ictal manic symptoms and their
relationship to a potential interictal bipolar disorder
deserves further study.
Deriving biologic explanations for the elevated
rate of bipolar symptoms in epilepsy is challenged by
our poor understanding of the mechanisms underly-
ing bipolar disorder. However, there are intriguing
possible common affectations of the limbic system,22
frontal and temporal regions,23-26 and noradrenergic,
dopaminergic, and serotonergic alterations.27-29
The finding of significant rates of bipolar symp-
toms in epilepsy should also be a consideration in the
strategy for selecting antiepileptic therapies for epi-
lepsy patients. If mood-instability or frank bipolar
symptoms are more common in epilepsy, then anti-
epileptic agents that have potential positive psycho-
tropic properties for these symptoms may be the
more optimal choices.
Clinicians should also bear in mind that while this
study has focused upon bipolar symptoms, many
other forms of psychopathology (such as depression,
anxiety, and psychosis) have been reported in epi-
lepsy and rates of some of these symptoms may actu-
ally exceed bipolar symptoms.30
Migraine also had a high rate of bipolar disorder,
although our analysis was not designed to assess
potential significant differences compared to asthma
or diabetes. As in epilepsy, the elevated rate of bipo-
lar in migraine may relate in part to bipolar and
migraine both involving the CNS. Another study31
found elevated rates of hypomania in patients with
migraine with aura. Our finding of bipolar symptoms
in 7.2% of migraine patients is close to the 8.6%
found in an interview survey of 1,000 consecutive
migraine patients2 and 8.8% in another similar
study,32 but lower than prevalence rates of migraine
as ascertained from populations with bipolar disor-
der (26%33 to 44%34). In migraine, the implications of
under-recognition of bipolar disorder are severe since
538 NEUROLOGY 65 August (2 of 2) 2005
antidepressants are commonly prescribed in mi-
graine which could elicit a manic state in patients
with bipolar disorder. Further, as in epilepsy, clini-
cians may want to prescribe antimigraine therapies
that are also helpful for bipolar symptoms, when
these two conditions coexist.
Possible explanations for a relationship between
bipolar disorder and diabetes have been well-
summarized elsewhere18 and include effects of lith-
ium or neuroleptics, and dysregulation of the
hypothalamic-pituitary-adrenal axis in both condi-
tions. An elevated rate of bipolar symptoms in
asthma is more unclear, but the potential bias of a
higher rate of bipolar diagnosis because of coming to
medical attention due to asthma as opposed to rarely
seeing a doctor should also be considered.
Among MDQ-positive cases, a previous diagnosis
of bipolar disorder was more likely among those with
epilepsy than other medical conditions studied. It is
possible that this reflects a particular likelihood for
epilepsy patients to come to medical attention for
cyclical mood disorder because of an increased focus
upon mood alterations in the context of seizures.
Neurologists may be more inclined to assess affective
and neurobehavioral symptoms when evaluating ep-
ilepsy patients.35 This further reinforces the need for
clinicians to include screening for affective disorders
into their routine clinical evaluations. Alternatively,
public awareness campaigns that educate the public
about the symptoms of affective disorder and the
need to discuss these symptoms with the physician
could also prove invaluable.
Another concerning finding was the high rates of
the diagnosis of unipolar depression in patients who
actually met criteria for bipolar illness by MDQ cri-
teria. This is important since effective treatments for
depression and bipolar disorder are different and ad-
ministration of antidepressants to patients with bi-
polar disorder can precipitate worse psychiatric
complications including mania36 or rapid cycling.37
With regard to statistical predictors of bipolar
symptoms, significant associations were observed in
all or nearly all medical subgroups with younger age,
male sex, and the reported presence of a family his-
tory of bipolar disorder. The association between
younger age and bipolar symptoms—including func-
tional impairment as recorded by the MDQ—was
previously noted for this study group,8 and in the
current dataset appears to cut across all medical co-
morbidities studied. It is possible that younger-aged
patients may be more inclined to be aware of mood
fluctuations and their functional repercussions, inde-
pendent of specific medical comorbidities.
Sex differences have not previously been reported
among bipolar patients with the exception of more
frequent rapid cycling as well as depressive and
mixed states38 in bipolar women than men. The
stronger relationship found between male sex and
bipolar symptoms among all medical subgroups ex-
cept those with diabetes runs counter to this existing
literature. Epidemiologic features of bipolar disor-
ders have not previously been well-described in the
literature, in part perhaps because of unresolved de-
bate about optimal inclusion and exclusion criteria
for the phenomenon. Prospective studies are needed
to further examine its potential sex differences as
contrasting with bipolar I disorder.
To our knowledge, there are no published family
history prevalence data regarding bipolar illness
among subjects with specific medical or neurologic
disorders, although the numerically higher rate
among subjects with epilepsy as compared to the
healthy comparison group observed in the present
study is consistent with possible shared neurobio-
logic mechanisms contributing to both disorders.
Further prospective data involving direct structured
interviews to assess family history may help to cor-
roborate this finding.
A limitation of our study was that identification of
bipolar symptoms was based upon a questionnaire
rather than a structured clinical psychiatric inter-
view. However, rigorously performed validation
studies of the MDQ have demonstrated that very few
patients identified with bipolar disorder are misdiag-
nosed.11 In the case of epilepsy, even if the MDQ had
false positives in some cases, up to 50% of MDQ
positive cases were previously diagnosed with bipo-
lar disorder. This number alone suggests that in the
routine clinical evaluation, physicians should inquire
about mood swings, unusually increased mental and
physical activity, decreased need for sleep, being ex-
cessively talkative, experiencing elated or irritable
moods, and disturbed social judgments.39
Another potential concern is that some items in
the MDQ such as “feeling irritable,” “thoughts raced
through the head,” “distracted by things around
you,” or “did unusual things” could have been inap-
propriately endorsed by some patients in reference to
distinct peri-ictal states. However, a review of table
E-2 reveals that epilepsy patients endorsed all items
with higher frequency (most significant in compari-
son to the frequency in other disorders). Even after
removing the four most likely potentially confound-
ing items, the group differences were still significant
and nearly all (11 of 13) of the individual items were
more common among those with epilepsy. Future
prospective, face-to-face studies would be helpful to
corroborate our findings.
Another issue regards limited knowledge of the
validity of the diagnosis of epilepsy or details of the
seizure disorder. Although a patient self-report is
perhaps less reliable than data from medical records,
potential errors in diagnosis would be constant
among all disease groups studied here. While many
patients with bipolar disorder have paroxysmal psy-
chosensory symptoms,40 we know of no data indicat-
ing that bipolar patients tend to be incorrectly
diagnosed with epilepsy at disproportionately high
rates, or have an impaired capacity to report their
health problems.
Because the MDQ is a symptom screening test, a
positive MDQ score should not automatically prompt
clinicians to prescribe medications for bipolar disor-
der; rather it should lead to a formal diagnostic eval-
uation examining the possibility of bipolar disorder.
Acknowledgment
The authors thank Kristina Fanning, PhD, and Kathy Ward for
assistance with manuscript preparation. They also thank Evelyn
Bromet, PhD, for methodologic suggestions.
Appendix
The Epilepsy Impact Project Group included Joyce Cramer, Patricia Dean,
Alan Ettinger, Patricia Gibson, Frank Gilliam, Cynthia Harden, Andres
Kanner, Patricia Shafer, and Michael Reed.
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 Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders
Alan B. Ettinger, Michael L. Reed, Joseph F. Goldberg, et al.
Neurology 2005;65;535-540
DOI 10.1212/01.wnl.0000172917.70752.05

This information is current as of August 22, 2005

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