Rapid cycling in severely multidisabled children: a form of bipolar affective disorder?

Pediatr Neurol. 1994 Feb;10(1):34-9. doi: 10.1016/0887-8994(94)90064-7.


A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled children. It was characterized by several days of lethargy, withdrawal, loss of abilities, irritability, and hypersomnolence followed or preceded by a high-energy state for several days during which the children slept very little, at times were euphoric, had improved mental ability, and were hyperactive. These cyclic episodes had been present for years but unexpectedly disappeared in one child. The etiology is unknown, in spite of detailed neurologic, metabolic, and endocrine investigations. All patients had family histories positive for affective disorder. Melatonin treatment helped to regulate the coexisting chronic sleep disorders of 3 children but failed to eliminate the cycles. Antiepileptic drug treatment, lithium, sedatives, stimulants, tranquilizers, and light therapy were largely ineffective. The children's symptoms and signs fit the diagnostic criteria of a bipolar affective illness, as it was modified for patients with associated neurologic disability; therefore, the patients appeared to have a unique disorder that closely resembles or is a variant of rapid cycling affective disorder.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anticonvulsants / therapeutic use
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / drug therapy
  • Bipolar Disorder / genetics
  • Bipolar Disorder / psychology
  • Child
  • Child, Preschool
  • Disabled Persons / psychology*
  • Female
  • Humans
  • Intellectual Disability / diagnosis*
  • Intellectual Disability / genetics
  • Intellectual Disability / psychology
  • Lithium / therapeutic use
  • Male
  • Neurocognitive Disorders / diagnosis*
  • Neurocognitive Disorders / drug therapy
  • Neurocognitive Disorders / genetics
  • Neurocognitive Disorders / psychology
  • Psychomotor Agitation / diagnosis
  • Psychomotor Agitation / psychology
  • Psychotropic Drugs / therapeutic use
  • Risk Factors
  • Sleep Stages


  • Anticonvulsants
  • Psychotropic Drugs
  • Lithium