Attention deficit and hyperactivity disorder in people with epilepsy: diagnosis and implications to the treatment

Abstract

The association between attention deficit and hyperactivity disorder (ADHD) and epilepsy can cause significant impact on the social life of affected individuals and their families. Clinical studies suggest that 30-40% of people with epilepsy also have ADHD. There are no studies which demonstrate that short or long-term treatment with methylphenidate increases the risk of seizures. Some studies attempt to relate drug interactions between methylphenidate and antiepileptic drugs, but adverse effects of methylphenidate have not been shown clearly. This review presents some neurobiological and physiopathogenic aspects, common to ADHD and epilepsy, from recent research studies, related to pharmacology, neuroimaging and electroencephalography. Possible risk of occurrence of seizures associated with the use of methylphenidate are also discussed. Key words: ADHD, epilepsy, methylphenidate, comorbidities, seizures, antiepileptic drugs.Transtorno de déficit de atenção e hiperatividade em pessoas com epilepsia: diagnóstico e implicações para o tratamento RESUMO A associação entre transtorno de déficit de atenção / hiperatividade (TDAH) e epilepsia pode causar importante impacto na vida social dos indivíduos afetados e seus familiares. Estudos clínicos sugerem que 30-40% das pessoas com epilepsia também apresentam TDAH. Não existem publicações que evidenciem que o tratamento a curto ou longo prazo com metilfenidato aumente o risco de ocorrência de crises epilépticas, e alguns estudos procuram relacionar as interações medicamentosas entre o metilfenidato e as drogas antiepilépticas, porém não foram demonstrados os possíveis efeitos do metilfenidato de uma maneira clara. Apresenta-se a seguir, revisão sobre os aspectos neurobiológicos e fisiopatogênicos comuns ao TDAH e epilepsia, a partir de pesquisas recentes relacionadas a estudos de farmacologia, neuroimagem e eletroencefalografia, e discuti-se os possíveis riscos da ocorrência de crises epilépticas associadas ao uso de metilfenidato.

Prevalence and associated factors of attention deficit hyperactivity disorder (ADHD) among Ugandan children; a cross-sectional study

“…This is a surprising finding because scientifically, epilepsy is thought to possibly increase the likelihood of having ADHD. Koneski et al [27] in a review article identifies possible common pathophysiological mechanisms between epilepsy and ADHD, which may help further understand the high prevalence of ADHD among epilepsy patients. The finding of epilepsy being protective against ADHD in this study could be explained by having epilepsy as the most common condition among study participants (71%) and yet a smaller proportion of the participants had ADHD (11.7%) compared to the bigger proportion of the participants (88.3%) who did not have ADHD.…”

Reappraisal of abnormal EEG findings in children with ADHD: On the relationship between ADHD and epileptiform discharges

“…It is well recognized that the relationship between these developmental disorders and epilepsy, particularly between ADHD and epilepsy, is very close, which is supported by evidence including research with animal models [1,2,[6][7][8][9][10].…”

“…Formerly, it was reported that 30-40% of children with epilepsy had ADHD, while 5-60% of children with ADHD had epileptiform discharges on their EEGs, and 10-20% of them were diagnosed as having epileptiform discharges [1,2]. It is, thus, suggested that epilepsy and ADHD may be two different independent expressions of a common neurobiological abnormality.…”

“…It was been suggested that there is a close relationship between attention-deficit hyperactivity disorder (ADHD) and epilepsy [1,2]. Recently, it was reported that the number of patients diagnosed as having ADHD during childhood and adolescence has been increasing [3][4][5].…”

Methylphenidate, cognition, and epilepsy: A 1‐month open‐label trial

“…Patients with epilepsy often suffer from inattention, memory impairment, and deficits in processing speed, which may be due to seizures, interictal epileptiform discharges, underlying brain disease, or antiepileptic drugs (AEDs). [1][2][3][4][5][6][7][8] Cognitive and attentional symptoms in these patients may be managed by reducing seizures, decreasing AED polypharmacy, or switching to AEDs with fewer cognitive side effects, but this often does not result in resolution of the aforementioned deficits. 9 Cognitive rehabilitation has been used in patients with epilepsy, but systematic evaluation of this approach in this population is inadequate.…”