Lithium treatment may be effective for both bipolar disorder and hypokalemic periodic paralysis, potentially due to correction of a common underlying pathophysiology involving Na, K-ATPase.
May support lithium in comorbid bipolar and HPP; hypothesis-generating and requires prospective trials before any practice change.
Primary periodic paralysis is a rare autosomal dominant disorder of ion-channel dysfunction, manifested by episodic flaccid paresis secondary to abnormal sarcolemma excitability. Membrane destabilization involving Na, K-ATPase has been hypothesized to be a biological etiology of the bipolar disorder (BD) and the mechanisms underlying lithium therapy have been linked to it. To date, there has been only one reported case of BD comorbid with periodic paralysis. Herein, we reported another case of concurrent bipolar mania and hypokalemic periodic paralysis (HPP), one special form of periodic paralysis. Consistent with the previous case, our patient responded well to lithium treatment for both bipolar mania and HPP. This might provide some support to the hypothesis that the therapeutic effects of lithium in both BD and HPP could be due to the correction of the underlying common pathophysiology.
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Shiah et al. (2015) studied this question.
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