Frequency of Epileptiform Discharges in the Sleep-Deprived Electroencephalogram in Children Evaluated for Attention-Deficit Disorders

Millichap, J; Stack, Cynthia V.; Millichap, J Gordon

doi:10.1177/0883073810371228

Cited by 30 publications

(28 citation statements)

References 20 publications

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“…The wide variation in the frequency of EEG abnormalities may be due to different research methods, duration of EEG, EEG activation, and the enrolled study subjects. In this retrospective study, the prevalence of EEG abnormalities among non-epileptic children with ADHD was 23.1%, which is similar to the average rate of eight studies (26.1%) summarized by Millichap et al [16] Compared to studies with awake only [15] or a lack of EEG studies, [13] the prevalence of EEG abnormalities in the current study is higher. However, the prevalence of abnormal EEG recordings in the current study is lower than that in studies with prolonged sleep recordings [20] or sleep-deprived EEGs [14,16].…”

Section: Discussionsupporting

confidence: 87%

“…Electroencephalography (EEG) has been used to evaluate electrical activity in the brain for some time, and several studies have demonstrated a high incidence of epileptic seizures and EEG abnormalities in children with ADHD [13][14][15][16][17]. Hemmer et al [13] reported the presence of epileptiform discharges in 36(15.4%) of 234 children with ADHD.…”

Section: Resultsmentioning

confidence: 99%

“…Hemmer et al [13] reported the presence of epileptiform discharges in 36(15.4%) of 234 children with ADHD. Millichap et al [16] examined 624 EEG records of children with ADHD and found abnormal discharges in 26.1%, and Lee et al [17] reported epileptiform discharges in 29 (16.1%) of 180 patients with ADHD. Some researchers have investigated the localization of EEG abnormalities in children with ADHD.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, in the study by Silvestri et al [20] 53.1% of the children with ADHD had epileptiform discharges, mostly in the centrotemporal region, during polysomnography, compared with only 18.7% of children with ADHD with standard abnormal EEG recordings. A review of eight published reports also showed a significantly higher prevalence of epileptiform abnormalities in non-epileptic children with ADHD in sleep EEG recordings compared to wake-only recordings [16,32]. It is reasonable that the frequency of EEG abnormalities is not proportional to clinical seizures.…”

Section: Discussionmentioning

confidence: 99%

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Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Li¹,

Chen²,

Hung³

2018

Neuropsychiatry

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Objective: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood, however few studies have investigated epileptic seizures and electroencephalographic abnormalities in children with ADHD. The aim of this study was to explore the occurrence of epileptiform discharges in children with ADHD. Method:We enrolled children with ADHD who visited the neurology clinic of our hospital between January 2014 and June 2016, all of whom met the DSM-V criteria and underwent awake and sleep electroencephalography examinations. We excluded those with histories of intellectual disabilities, epilepsy, congenital anomalies and substance abuse. None of the patients had a history of seizures before the examination.Results: A total of 121 patients were included (93 males, 28 females, mean age 6.9±2.5 years), of whom 28 (23.1%) had electroencephalographic abnormalities, including three (10.7%) with generalized epileptiform discharges and 25 (89.3%) with focal epileptiform discharges. The focal epileptiform discharges were most prevalent from the rolandic area (15/25), followed by the parietal area (5/25), frontal area (4/25) and occipital area (1/25). Fourteen (50%) of the 28 patients had abnormal electroencephalographic findings only during sleep recordings. Conclusions:Electroencephalographic focal abnormalities were found in 23.1% of our patients, of which 50% appeared only during sleep recordings. We suggest that sleep and awake electroencephalography recordings should be part of the routine assessment of children with ADHD regardless of whether or not they have overt seizures or other neurological conditions. In patients who do not respond well to traditional ADHD drugs, treatment for paroxysmal electroencephalographic abnormalities may be considered.

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Section: Discussionsupporting

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Li¹,

Chen²,

Hung³

2018

Neuropsychiatry

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“…A more objective test such as EEG if validated could be a valuable aid in the diagnosis and management of ADHD. The significance of seizure discharges in approximately 25% of sleep-deprived EEGs in ADHD children is further evidence of the utility of the EEG in ADHD management [3]. …”

mentioning

confidence: 98%

Treatment of ADHD: Effect of Methylphenidate on Inattention during Driving

Millichap¹,

Millichap²

2014

Pediatr Neurol Briefs

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COMMENTARY. The FDA approved the Neuropsychiatric EEG-Based ADHD Assessment Aid (NEBA) medical device in 2013 to be used as confirmatory support or to pursue further testing after an evaluation for ADHD, in a child aged 6-17. The device was not to be used as a stand alone method of diagnosis of ADHD.The AAN, in an Evidence-Based Practice Advisory, concludes that it is highly likely that EEG theta-beta power ratio and EEG frontal beta power correctly identify patients with ADHD (accuracy 89% to 94%) as compared to a clinical evaluation. The AAN recommends that the EEG test should not be used in place of a standard clinical evaluation, because of the risks of misdiagnosis of 6-15% when using the theta/beta ratio. There is neither evidence for, nor against the use of theta/beta EEG power ratio either to confirm a diagnosis of ADHD, nor to support further testing. Whether comorbid disorders such as ODD have similar changes in the theta/beta ratios that mimic the reported finding in ADHD is not known [1].A recent report of spectral analysis of EEGs on 28 normal and 58 ADHD children, aged 6 to 14 years, found TBR was higher in ADHD subjects, with lower beta but no difference in theta power over Broca's area. Beta-1 power over Broca's area was the best diagnostic test, with sensitivity 0.86 and specificity 0.57. The EEG beta-1 power and TBR assist in confirming the diagnosis of ADHD in a sample with moderate pretest probability of ADHD [2].The present symptomatic method of diagnosis, based on parent and teacher evaluations, is relatively accurate in children with the hyperactive-impulsive subtype of ADHD but less so with the inattentive type. A more objective test such as EEG if validated could be a valuable aid in the diagnosis and management of ADHD. The significance of seizure discharges in approximately 25% of sleep-deprived EEGs in ADHD children is further evidence of the utility of the EEG in ADHD management [3].

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