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Medical Edge Newspaper Column from Mayo Clinic

NEW TEST FOR BIPOLAR DISORDER COULD PREVENT MISDIAGNOSES

DEAR MAYO CLINIC: I read with great interest about Mayo Clinic’s research using brain scans to identify specific brain chemicals related to bipolar disorder. My daughter is bipolar, and I have classic bipolar symptoms. Is the procedure available to the public? — Anonymous

ANSWER: The procedure you read about is magnetic resonance spectroscopy, and, if our study results are replicated, a diagnostic test for bipolar illness could be available within three to five years.

In the study, we used MR spectroscopy — a special form of MR imaging that allows researchers to analyze the chemical properties of tissues — to examine the brains of 21 previously diagnosed bipolar patients (who weren’t using any medication) and 21 normal volunteers.

The scans showed that bipolar patients had consistently different levels of five chemicals that are believed to be present in abnormal quantities in people with the illness. The areas of the brain that control behavior, movement and sensory information were affected. These chemical differences were clearly visible within the brain based upon the mood state of the patient. Also, patients with severe bipolar disorder had different chemical patterns from patients with only mild to moderate cases, suggesting that severe bipolar disorder may require a different or more aggressive treatment.

This is exciting preliminary work that we hope will lead to a clinical test for bipolar disorder. The next step is to study patients being treated for bipolar disorder to determine if MR spectroscopy can detect changes in brain chemistry in response to treatment.

Here’s some background on bipolar disorder that may help you as you consider care for yourself and your daughter: Approximately 2.3 million Americans suffer from this condition. It is characterized primarily by wide emotional swings — from the euphoria of mania to the listlessness of depression. In many cases, only the depression phase of the illness is recognized, not the manic phase, making bipolar disorder difficult to diagnose. This is important because the therapies used for bipolar disorder differ from those employed to fight depression.

Since most diagnoses are made based on discussions with the patient, a clinically useful diagnostic tool such as MR spectroscopy would greatly help the psychiatric community diagnose bipolar disorder.

At this time, medication and psychotherapy are the main treatments for bipolar disorder. You should continue to work with your medical team to determine the best course of treatment for you and your daughter.

— John D. Port, M.D., Ph.D., Diagnostic Radiology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Bipolar Disorder
Appointment Information
More Information on Bipolar Disorder

READERS: Researchers recently reported on a new way to permanently prevent pregnancies by blocking the fallopian tubes, called hysteroscopic sterilization. It may be an appealing alternative to the most commonly used method of sterilization for women — laparoscopic tubal ligation — because it costs about $500 less, requires minimal sedation and no incision. Moreover, the patient typically leaves the hospital within an hour.
This technique involves inserting a nickel-titanium and stainless steel springlike device into the fallopian tubes using a hysteroscope — a tiny, fiber-optic camera. The metal device encapsulates and holds in place white polyester fibers that cause scarring, blocking the fallopian tubes within 12 weeks. This sterilization method requires minimal sedation and no surgical incision, as the surgeon enters via the vagina. It also allows for a quick recovery.

Additional Resources:
More Information on Sterilization
Appointment Information
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2005 TRIBUNE MEDIA SERVICES, INC.

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.