Q. My 6-year-old daughter has recently been diagnosed with early onset biploar I disorder. The doctor suggested that we might want to get an EEG and MRI to see if there is seizure activity going on. Before she started on Zyprexa, she would often go directly into a violent rage upon waking, and now continues to be more at risk for a rage when she is very tired.

Can you explain what an EEG or MRI might show that would be useful in treatment?

A. Your doctor is being appropriately cautious. Although bipolar disorder certainly can be seen in children as young as 5 or 6 years old (contrary to popular belief), it is unusual. That means that medical and neurological causes for abnormal behavior must be ruled out. That your daughter's symptoms seem somehow related to sleep/wake cycles does raise the question of some type of sleep-related or seizure-related cause, since the brain's electrical rhythms are altered during transitions from sleep to wakefulness.

Some people have nocturnal seizures that may manifest as violent of unusual behavior. Others may show abnormal behaviors during REM (rapid-eye movement) sleep. An EEG (electroencephalogram) --or, better yet, an overnight sleep recording called a PSG--could be very helpful. It may show mild abnormalities (so-called "slowing" of the electrical rhythm) even if the patient is not actually having a seizure.

The MRI may show abnormalities in certain brain regions (such as the temporal lobe) that may point to a cause of seizures. Depakote might tend to suppress abnormal electrical activity and, ideally, might better be tapered off a couple of days before the EEG or PSG, but that is a clinical decision only your daughter's doctor can make.

If you are in any doubt about the diagnosis or treatment, I would recommend obtaining a second opinion (with your doctor's cooperation) from a specialist in pediatric neurology or childhood bipolar disorder. I hope things work out for you and your daughter.

January 2003

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