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

Abstract

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.

Self-reported attention and hyperactivity symptoms among adults with epilepsy

“…The higher frequency of symptoms of ADHD, depression, and anxiety among PWE is in accordance with the existing scientific literature, in which the presence of epilepsy has been associated with a higher prevalence of such psychiatric comorbid disorders than that observed in the general population. 3 4 8 9 10 11 12 13 16 26 27 28 29 30 31 A history of epilepsy and/or febrile seizures during childhood has been linked to an increased risk of developing ADHD. 32 Albeit ADHD is more frequent among the pediatric population with epilepsy, adult PWE have also shown a higher prevalence of ADHD when compared with the general population, 12 13 16 and our finding of a higher ADHD symptoms burden among PWE is consistent with the current literature and replicates its findings in the Brazilian population.…”