High Yield of Screening for ADHD in the Epilepsy Monitoring Unit

Dunbar, Corrinne; Lee, Maxwell; Maheshwari, Atul

doi:10.1177/1087054719886359

Cited by 7 publications

(17 citation statements)

References 36 publications

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“…Recent literature has shown that ADHD is not only a common comorbidity with epileptic seizures but also with PNES (Say et al., 2015 ; Simani et al., 2020 ). Our prior study found that out of all patients diagnosed with PNES, 63.6% screened positive using the Adult ASRS, compared to 27.8% in patients with ES (Dunbar et al., 2019 ). Our current study is consistent with this previous work, where PNES patients were found to have an admission diagnosis of ADHD at a greater rate than PWE, although this difference was not statistically significant (Table 1 ).…”

Section: Discussion/conclusionmentioning

confidence: 97%

“…Future research can be aimed at providing a more streamlined ability to screen, diagnose, and treat patients with seizures and comorbid ADHD. The Adult ASRS is useful in screening for ADHD in this population (Dunbar et al., 2019 ). While the ASRS does not formally diagnose a patient with ADHD, it may be used as a tool along with other clinical factors to assess which patients require further formal evaluation for ADHD (Chamberlain et al., 2021 ).…”

Section: Discussion/conclusionmentioning

confidence: 99%

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Low recognition of attention deficit hyperactivity disorder in adult patients admitted to the Epilepsy Monitoring Unit

et al. 2022

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Introduction Adult patients with epilepsy (PWE) have an 18% prevalence of comorbid attention deficit hyperactivity disorder (ADHD) compared to a prevalence of 2%–5% in the general population. Recognition of this dual diagnosis is important since stimulant therapy is both safe and effective in this population. Methods Here, we aim to determine if PWE have adequate documentation for comorbid ADHD when being admitted to the Epilepsy Monitoring Unit (EMU). A retrospective review was conducted at the Baylor St. Luke's Medical Center EMU for patients presenting between July 2017 and November 2020. Patients were divided into two groups: Group I—patients without a documented ADHD diagnosis or ADHD medications and Group II—patients with a documented ADHD diagnosis and/or taking medications indicated specifically for ADHD. Results Of 524 individual patients who presented to the EMU, only 25 patients (4.8%) had documentation of a diagnosis of ADHD and/or ADHD medications (Group II). The proportion of patients in Group II did not significantly differ based on the EMU diagnosis. However, there was a significantly greater number of other psychiatric diagnoses (p = .005) and a greater number of psychiatric medications prescribed (p < .001) in patients in Group II. Conclusion Our study suggests that ADHD is underrecognized and underdiagnosed in patients presenting to the EMU, and screening tools may be useful to help clinicians address seizure comorbidities such as ADHD.

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Section: Discussion/conclusionmentioning

confidence: 97%

Section: Discussion/conclusionmentioning

confidence: 99%

Low recognition of attention deficit hyperactivity disorder in adult patients admitted to the Epilepsy Monitoring Unit

et al. 2022

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“…One possibility is that focal seizures are more likely to be acquired later in life secondary to a focal injury, which may preclude the neurodevelopmental profile expected from patients with ADHD. In addition, patients with unknown etiologies due to negative MRI and EEG may be more likely to have psychogenic non-epileptic seizures, which we have previously found to have a higher likelihood of screening positive with the ASRS-v1.1 than patients with epilepsy in an Epilepsy Monitoring Unit (EMU) setting (Dunbar et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Screening for ADHD in Adult Patients With Epilepsy: Prevalence of Symptoms and Challenges to Diagnosis

Nguyen,

Xiao,

Clark

et al. 2023

J Atten Disord

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Objective: Given the complex nature of seizure disorders and their treatments, ADHD may be underdiagnosed in this population. We hypothesized that a higher percentage of patients presenting to a seizure clinic would endorse ADHD symptoms compared to rates reported in the general population and that formal screening for ADHD symptoms would identify patients with previously undiagnosed comorbid ADHD. Methods: In this study, we surveyed 312 adults in a seizure clinic using the Adult ADHD Self-Report Scale (ASRS-v1.1). Results: We found that 90 patients (28.8%) screened positive with the ASRS-v1.1, but only nine of these patients were able to complete neuropsychological testing,. Out of these patients, only one was diagnosed with possible ADHD. Conclusion: Through this process, we identified many challenges to making a new ADHD diagnosis in this population, including attention deficits due to other medical or psychiatric diagnoses, a positive urine drug screen, lack of collateral report/information about developmental history, and barriers to neuropsychological evaluation.

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“…Patients who screened positive for ADHD using the ASRS criteria were also found to have an increased prevalence of comorbid psychogenic non-epileptic seizures (PNES) compared to epileptic seizures in the epilepsy monitoring unit (EMU) [21]. This provides further compounding evidence that ADHD is often comorbid with other psychiatric conditions.…”

Section: Screening For Adhdmentioning

confidence: 99%

“…These acute stressors commonly affecting children at this age include tense interpersonal relationships between siblings and marriage difficulties between parents. The diagnosis of ADHD in adolescents greater than the age of 12 is less common, therefore physicians should be vigilant when screening for these acute stressors including school bullying and depression[21]. First-line treatment for ADHD in preschool-aged children (4-5 years old) is behavioral therapy administered by parents or teachers.…”

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confidence: 99%

Attention Deficit Hyperactivity Disorder and Substance Use Disorder: A Narrative Review

Srichawla¹,

Telles²,

Schweitzer³

et al. 2022

Cureus

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Attention deficit hyperactivity disorder (ADHD) has a growing incidence and prevalence in the United States and throughout the world, much of which is contributed to increased awareness of the condition and solidified diagnostic criteria. Substance use disorder (SUD) similarly has seen a sharp increase, particularly with the rising cases of opioid abuse. Management of ADHD is done primarily with pharmacologic therapy, often stimulants and with psychosocial interventions (i.e., exercise, meditation, peer-to-peer intervention, etc.) for adjunctive management. Management of SUD involves cessation and treatment based on the underlying drug of abuse. Many clinicians are uncomfortable treating ADHD in patients with SUD based on concerns the intervention may lead to an adverse event, including drug relapse, and the development of other psychiatric comorbidities. Concerns also arise about stimulants acting as a gateway drug in adolescents leading to the onset of SUD. Thus, in this narrative review, we aim to shed light on ADHD in relation to SUD and to provide clinical insight based on the current scientific literature on the topic. ADHD causes lesions in subcortical structures in the basal ganglia and limbic system. Treatment of ADHD with stimulants has been shown to normalize malformed neuroanatomical variations and lead to improved long-term outcomes compared to nontreatment of ADHD. Based on current scientific literature, it is recommended to treat ADHD with guidelinedirected pharmacologic agents including stimulants along with non-pharmacologic interventions primarily exercise. There may be some improvement in reducing risky behavior, such as substance abuse, and may even help prevent the development of SUD.

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High Yield of Screening for ADHD in the Epilepsy Monitoring Unit

Cited by 7 publications

References 36 publications

Low recognition of attention deficit hyperactivity disorder in adult patients admitted to the Epilepsy Monitoring Unit

Low recognition of attention deficit hyperactivity disorder in adult patients admitted to the Epilepsy Monitoring Unit

Screening for ADHD in Adult Patients With Epilepsy: Prevalence of Symptoms and Challenges to Diagnosis

Attention Deficit Hyperactivity Disorder and Substance Use Disorder: A Narrative Review

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