Q:  PET Scan & Bipolar Disorder

We have just gone through a horrific four years until after my husband of 30 tried to commit suicide, and was diagnosed as bipolar. His father is also bipolar, having gone through shock therapy in the 60's, and recently found out the paternal grandmother died by committing suicide. My husband's sister is bipolar and his brother- usually depressed or frantically involved is some sort of get-rich-quick scheme.
 
My question is,that I am seeing signs of bipolr tendencies in my 19 year old son. He had a seizure on March 31, and the nerologists has just finished most of his testing and can not find a definative cause. In the state of Florida, a PET test can now be given and covered under insurance when someone has a seizure. The nerologist is willing to have the test done, but he is unable to read it for bipolar/psychiatric purposes. I read that they are using the PET test to help diagnose bipolar illness. Do you know of an expert in this area that I can contact to help with an evaluation of this testing for my son? We live in Boynton Beach, FL

My husband suffered so many years of his life not understanding what was wrong with him. I would love to have a definative analysis of our son, so he could get help if necessary.

Your timely response would be greatly appreciated. His test will be sometime next week.

Gratefully,


Dear Ms. K' -- 
Dr. Terry Ketter has been one of the leading researchers in this area for years (at NIMH before moving several years ago to Stanford).  Here's a recent summary from his group.  Based on this, I'm afraid if you called Stanford you'd be told the PET scan is not ready for diagnosis/treatment yet, but certainly you can ask.  Perhaps their Neuropsychiatry Imaging Lab would be the place to start, or otherwise the Dep't of Psychiatry.  

The other resource with this kind of capacity that's much closer to you is Mark George's lab at Univ. of South Carolina; you could conduct the same inquiry there.  Good luck.  You might be a little early.  

Meanwhile, you could wonder out loud with the neurologist treating your son's seizure if she/he could use a medication that has demonstrated efficacy in bipolar disorder, while they're at it (as long as that is consistent with the best possible treatment of the seizure), e.g. Depakote, Tegretol or possibly Trileptal in that role, or maybe even lamotrigine although it's antimanic efficacy appears not as strong as the rest and I still worry it can push things in a manic direction in at least a few people.  At least asking about this would not be out of line, or shall we say, I've made the same request of a neurologist when a patient I'm treating for bipolar disorder has a seizure, so there's a precedent anyway, which seems to me to be worth considering even before a clear diagnosis of bipolar disorder is warranted.   

Dr. Phelps

Published July, 2003