Preliminary communication An investigation into the relationship between first-degree relatives of bipolar affective disorder and (idiopathic) epilepsy in a sub-Saharan African population M.S. Jidda n , M.A. Wakil, A.W. Ibrahim, A.O. Mohammed Department of Mental Health, College of Medical Sciences, University of Maiduguri, PMB 1069 Maiduguri, Nigeria article info Article history: Received 4 February 2014 Accepted 28 February 2014 Available online 13 March 2014 Keywords: Bipolar disorder Epilepsy Relationship Sub-Saharan Africa abstract Objective: Phenomenological, neuro-biological and pharmacological investigations linked bipolar affec- tive disorders with epilepsy. Similarly, a large community-based epidemiological study of epileptic patients reported that 12% of the participants had bipolar symptoms, a rate 7 Â higher than in control. Bipolar and epileptic disorders are epiphenomena of an underlying genetic susceptibility. This study aimed to determine the relationship between first-degree relatives of bipolar and epileptic patients in a sub-Saharan African population. Method: In this case-control study, we used a socio-demographic and clinical variables questionnaire to assess random convenient samples of 50 control, 40 and 60 first-degree relatives of bipolar and epileptic patients, respectively at Federal Neuro-psychiatric Hospital (FNPH), Maiduguri. Relatives of epileptic patients and the control completed the mood disorder questionnaire (MDQ). Two consultant psychia- trists made the diagnosis of epilepsy using the ILAE criteria, in relatives of bipolar patients and the control. Participants in both groups had no EEG. We analysed the data obtained, using EPI-info 7 to report averages and associations between categorical variables with Chi-square test, and analysis of variance (ANOVA) for parametric data (statistical significance set at p ¼0.5, two-tailed). Results: The rate of epilepsy among relatives of bipolar disorder compared with control was 15.2% vs. 2.0% (χ 2 ¼46.08, p o0.001), and that of bipolar among relatives of epileptics compared with control was 14.5% vs. 2.1% (χ 2 ¼31.2, p o0.001). Educational status showed significant relationship across two groups (χ 2 ¼24.19, p ¼0.0001). Using ANOVA, age showed significant relationship among relatives of bipolar and epileptic patients (F ¼5.769, p ¼0.0039). Conclusion: Despite its limitations, this preliminary study contributes to literature on the relationship between epilepsy and bipolar affective disorder in sub-Saharan Africa. & 2014 Published by Elsevier B.V. 1. Introduction Phenomenological, neuro-biological and pharmacological investi- gations linked bipolar affective disorders with epilepsy. Studies in western Nigeria (Dada, 2006; Osuntokun et al., 2007; Goodridge and Shorvon, 1983) found prevalence rates of 3.1–5.3 per 1000 for epilepsy. However, a more recent review (Akinsurole and Adewuya, 2010) reported higher rates of 5.3–37 per 1000 for the disorder, in the region. Bipolar disorder is rare among Nigerians (Gureje et al., 2006) and the rate of the disorder in the general population is 1.5– 2.5% (Akiskal et al., 2000). A community-based studies of epileptic patients in the US (Ettinger, 2005; Marco et al., 2008) found that 12% of the participants had bipolar symptoms, a rate higher than symptoms of other medical disorders. Epileptic patients had 2.2 Â and 6 Â more bipolar symptoms compared with migraine and a healthy control (Ettinger, 2005) respectively. Studies, including randomized control trials showed evidence for the efficacy of anti- epileptic drugs in the management of bipolar affective disorders (NICE Guideline, 2008; Mazza, 2007; Mula et al., 2010). Many studies found that depression is a common psychiatric comorbidity in epilepsy, but we know little about the relationship between epilepsy and bipolar affective disorders (bipolar depression, and mania). Similarly, biochemical, structural, and functional changes of primary bipolar disorder occur secondary to seizure disorders (Mula, 2010). Kindling phenomenon that increased our understanding of seizure disorders also explains the episodic nature of bipolar disorders (Mula, 2010; Clarke et al., 2012). In bipolar patients, Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2014.02.040 0165-0327/& 2014 Published by Elsevier B.V. n Corresponding author. E-mail addresses: tumbanakaka@hotmail.com, msjidda@gmail.com (M.S. Jidda). Journal of Affective Disorders 161 (2014) 84–86