RAPID-CYCLING IN SEVERELY MULTIDISABLED CHILDREN - A FORM OF BIPOLAR AFFECTIVE-DISORDER

A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled children. It was characterized by several da ys of lethargy, withdrawal, loss of abilities, irritability, and hyper somnolence followed or preceded by a high-energy state for several day s during which the children slept very little, at times were euphoric, had improved mental ability, and were hyperactive. These cyclic episo des had been present for Sears but unexpectedly disappeared in one chi ld. The etiology is unknown, in spite of detailed neurologic, metaboli c, and endocrine investigations. All patients had family histories pos itive for affective disorder. Melatonin treatment helped to regulate t he coexisting chronic sleep disorders of 3 children but failed to elim inate the cycles. Antiepileptic drug treatment, lithium, sedatives, st imulants, tranquilizers, and light therapy were largely ineffective. T he children's symptoms and signs fit the diagnostic criteria of a bipo lar affective illness, as it was modified for patients with associated neurologic disability; therefore, the patients appeared to have a uni que disorder that closely resembles or is a variant of rapid cycling a ffective disorder.