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Table 1: Contd...
Case Gender BD BD type Treatment; response MS MS presentation and Neuroimaging findings Reference
number onset onset course
18 Male 21 BD-I Li + APs; 31 Progressive spastic and MRI: lesions in centrum [14]
poor response ataxic quadriparesis semiovale, periventricular
regions, subcortical areas,
thalamus, temporal lobes;
cerebral atrophy
19 Female 22 BD-I NS 27 R/R brainstem and MRI: three lesions in the [14]
cervical cord periventricular area of
right hemisphere, one
lesion in the left cerebellar
hemisphere
20 Female 33 BD-I Li + ADs; 33 R/R brainstem, lower MRI: periventricular and [23]
good response paraparesis, ataxic gait temporal horn lesions, one
lesion in the right fronto-
basal region, bilateral
lesions in the splenium of
corpus callosum, corona
radiata, centra semiovalia,
few subcortical lesions;
moderate atrophy in supra-
tentorial compartment and
trunk of corpus callosum
21 Female 48 BD-I NS 48 R/R neuropsychiatric Neuropathology: small, [24]
symptoms (+ atonic atrophic brain; moderate
bladder developed at ventriculomegaly;
age 81) numerous lesions in
periventricular location,
right superior frontal
convolution, cingulate
gyrus, centrum semiovale,
corpus callosum, left
cerebellar folia
22 Male 20 BD-I NS 40 Mild pyramidal signs on MRI: lesions in the [20]
the left side periventricular and
subcortical areas, bilateral
centrum semiovale,
corpus callosum
23 Female 26 BD-I AP; full resolution 26 R/R brainstem MRI: one lesion located [25]
parasagittally within the
left parietal lobe
24 Female 39 BD-I APs + AD; 40 R/R motor deficit left MRI: lesions in [26]
full resolution side, gait impairment, periventricular area and
urinary incontinence cervical cord
25 Male 20 BD-I Li; poor response 31 R/R paresthesia and MRI: lesions in [27]
weakness left side, periventricular area,
urinary incontinence corpus callosum, cervical
spine at C2 and C3
26 Female 20 BD-I Li; good response 32 R/R quadripyramidal MRI: multiple lesions [27]
syndrome with right in periventricular and
kinetic cerebellar semioval areas, cervical
syndrome spine at C6
BD: bipolar disorder; MS: multiple sclerosis; Li: lithium; NR: not reported; NS: not specified; R/R: relapsing remitting; MRI: magnetic resonance imaging;
AP: antipsychotic; AE: antiepileptics; AD: antidepressant

We did not find any correlation between BD type and of onset of both BD and MS were higher than those
MS course type nor between the pattern of white matter reported in the literature. Furthermore, the mean
lesions and BD type, although lesions were commonly difference between BD onset and MS is 5 years although
detected in the periventricular and subcortical white 9 patients (34.6%) had the onset of BD and MS at the
matter, the centrum semiovale bilaterally, frontal, same age. The higher age of onset of MS may indicate
parietal and temporal lobes. that only the form with a later age of onset increases
the risk or the co‑occurrence/comorbidity with BD.
CONCLUSION
A high percentage of BD presented with manic
The survey of the literature found few epidemiological episodes (single/recurrent), a finding that may indicated
studies and several case reports of BD clearly preceding differences between BD occurring in MS patients and
MS onset. Based on these data, only limited conclusions those in the general population. Similarly, the higher
can be drawn. In the sample analyzed, the mean ages rate of psychotic features and the low rate of positive

198 Neuroimmunol Neuroinflammation | Volume 2 | Issue 4 | October 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 4 | October 15, 2015 199