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Topic: Neurovascular and neuroinflammation mechanisms

associated with bipolar disorder

Bipolar disorder preceding the onset of multiple

sclerosis

Ciro Marangoni , Maria Giulia Nanni , Luigi Grassi , Gianni L. Faedda 2,3
1
1
1
1 Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy.
2 Lucio Bini Mood Disorders Center, New York, NY 10022, USA.
3 Child Study Center, New York University Langone Medical Center, New York, NY 10016, USA.

ABSTRA CT
Multiple sclerosis (MS) is the most common inflammatory demyelinating brain disease. The occurrence of psychiatric disorders,
especially for major depression, in the course of MS is high. Reports concerning bipolar disorder (BD) remain rather scarce although
early descriptions were found in the old neurological literature. The purpose of this article is to provide a critical review of the
epidemiology, comorbidity, and treatment findings regarding BD preceding the onset of MS.

Key words: Bipolar disorder, comorbidity, multiple sclerosis, onset

INTRODUCTION Bipolar disorder (BD) is a major psychiatric illness with
an estimated lifetime prevalence of 2.1% among United
Multiple sclerosis (MS) is the most common autoimmune States adults. In regard to gender, BD type I occurs with
disease of the central nervous system associated with equal frequency in both men and women, but BD type II
inflammatory demyelination. In the United States, the is more common in women, accounting for up to 30‑40%
prevalence of MS is 0.1%. MS affects more women than of previously diagnosed unipolar depression. The age
[1]
men, with an estimated female‑to‑male ratio of about of onset of BD is most commonly around 20 years of
2:1. The median and mean ages of MS onset are 23.5 age (peaking at ages 15‑25 years). BD men appear to have
and 30 years of age, respectively. The peak age of onset 4‑5 years earlier onset than BD women. First onset mania
is about 5 years earlier for women, but the onset of MS is very rare among elderly people.
can rarely occur as late as the 7th decade.
The pathophysiology of BD is heterogeneous. Recent
Although the etiology of MS is unknown, the most widely scientific findings consider BD as a suite of related
accepted theory is that MS begins as an inflammatory neurodevelopmental conditions with interconnected
autoimmune disorder mediated by autoreactive functional abnormalities, early onset, and worsening
lymphocytes. Later, the disease is dominated by over time. In addition to accelerating loss of volume
microglial activation and chronic neurodegeneration. in brain regions known to be essential for mood
Inflammation, demyelination, and axon degeneration regulation and cognitive function, consistent findings
are the major pathologic mechanisms that cause the have emerged at a cellular level, providing evidence
clinical manifestations. that BD is reliably associated with dysregulation of
glial‑neuronal interactions, especially microglia which
Corresponding Author: Dr. Ciro Marangoni, appear to be overactive. Furthermore, inflammation
Institute of Psychiatry, Department of Biomedical and in the periphery of the body is increased in both
Specialty Surgical Sciences, University of Ferrara, Corso depressive and manic phases of the illness, with at least
Giovecca 203, 44121 Ferrara, Italy.
E‑mail: ciromarangoni@hotmail.com
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Cite this article as: Marangoni C, Nanni MG, Grassi L, Faedda GL.
DOI: Bipolar disorder preceding the onset of multiple sclerosis. Neuroimmunol
10.4103/2347-8659.167302 Neuroinflammation 2015;2:195-9.
Received: 13-03-2015; Accepted: 06-08-2015

© 2015 Neuroimmunology and Neuroinflammation | Published by Hongkong Partner Publishing Co. Limited 195