Comorbid seizure disorder

A therapeutic range should be established for each patient. This range should define concentrations that result in minimal side effects and optimal seizure control. This therapeutic plasma concentration range should be used to identify the appropriate patient-specific dose. Patients should be monitored chronically for seizure control, comorbid conditions, social adjustment (including quality-of-life assessments), drug interactions, compliance, and adverse effects. Periodic screening for comorbid neuropsychiatric disorders such as depression and anxiety is also important. Clinical response is more important than the serum drug concentration. 

To summarize, comorbidities on which a manic syndrome can be superimposed include ADHD, ODD, conduct or pervasive developmental disorders, Tour-ette s syndrome, or medical conditions such as brain tumors, multiple sclerosis, temporal lobe seizures, human immune-deficiency syndrome (HIV), and endocri-nopathies such as hyperthyroidism and Cushing s syndrome (James and Javaloyes, 2001). Organic affective syndrome, a condition given separate designation in DSM I-IIIR, is now subsumed under mood disorder due to a general medical condition in DSM IV. Substance induced mood disorder has a similar due to. . . designation. 

Mood Stabilizers (Lithium and Anticonvulsants). Due to the lack of evidence demonstrating their benefit, lithium and anticonvulsants are reserved for BN patients with a comorbid bipolar affective disorder. Target serum concentrations and doses are similar to those used for patients with seizure or mood disorders. Lithium must be used cautiously, because purging and laxative abuse increases the risk of toxicity. The adverse effect of weight gain often makes mood stabilizers and anticonvulsants unacceptable to patients in the long term. 

Although the etiology of autism is not understood, the defining or core symptoms of autistic disorder are considered to be impaired social interaction, impaired verbal and nonverbal communication, and restrictive, repetitive patterns of behavior. In addition, most patients with a primary diagnosis of autism exhibit other neurological or psychiatric symptoms, which may include seizures, sleep disorders, anxiety, panic attacks, attention deficit/hyperactivity, self-injury, and cognitive impairment (Simonoff et ah, 2008). It is not known to what extent these comorbidities reflect the primary pathology of autism and to what extent they represent unrelated vulnerabilities that are exacerbated by the impaired social interaction and communication that is characteristic of the disorder. 

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