Epileptiform abnormalities and quantitative EEG in children with attention-deficit / hyperactivity disorder

Abstract

-There is much controversy about the importance of the electroencephalogram (EEG) in assessing the attention-deficit/hyperactivity disorder (ADHD). The objective of this study was to assess the use of EEG and quantitative EEG (qEEG) in ADHD children. Thirty ADHD children and 30 sex-and age-matched controls with no neurological or psychiatric problems were studied. The EEG was recorded from 15 electrode sites during an eyes-closed resting condition. Epileptiform activity was assessed, as were the absolute and relative powers in the classical bands after application of the Fast Fourier transform. Epileptiform activity was found in 3 (10%) ADHD children. As compared to the controls, the ADHD group showed significantly greater absolute delta and theta powers in a diffuse way, and also greater absolute beta power and smaller relative alpha 1 and beta powers at some electrodes. A logistic multiple regression model, allowed for 83.3% sensibility and specificity in diagnosing ADHD.KEy worDs: attention-deficit/hyperactivity disorder, EEG, children. Atividade epileptiforme e eletrencefalograma quantitativo em crianças com transtorno de déficit de atenção/hiperatividadeResumo -Há controvérsias sobre a importância do eletrencefalogama (EEG) na avaliação do transtorno de déficit de atenção/hiperatividade (TDAH). o objetivo deste estudo foi avaliar, em crianças com TDAH, o EEG digital e quantitativo. Foram estudadas 30 crianças com TDAH e 30 sadias, sem evidências de problemas neurológicos ou psiquiátricos e pareadas por idade e gênero. Foi registrado o EEG em 15 posições de eletrodos, durante repouso e olhos fechados. Foi realizada pesquisa de atividade epileptiforme e feita análise de freqüências nas faixas clássicas, após aplicação da transformada rápida de Fourier. Foi encontrada atividade epileptiforme em 3 (10%) crianças com TDAH. o grupo TDAH teve, em relação ao grupo controle, significativamente, maior potência absoluta delta e teta, de modo difuso, assim como maior potência absoluta beta e menor potência relativa alfa 1 e beta, em alguns eletrodos. Um modelo de regressão múltipla logística possibilitou sensibilidade e especificidade de 83,3% no diagnóstico de TDAH.PAlAvrAs-cHAvE: transtorno de déficit de atenção/hiperatividade, EEG, infância. The attention-deficit/hyperactivity disorder (ADHD) is one of the commonest behavioral disorders in childhood. Due to advancing knowledge with respect to the prevalence, natural history, genetics, biology and treatment of ADHD, a greater number of patients are now receiving adequate treatment. The diagnosis of ADHD is based on the DsM Iv 1 criteria of which the essential characteristic consists of a persistent pattern of lack of attention and/ or hyperactivity-impulsivity more frequent and serious than that typically observed in individuals with an equivalent developmental level. some symptoms of hyperactivity and impulsivity should be present up to 7 years of age. some compromise due to the symptoms should be present in at least two contexts (e.g. at home or at school ...

Electrical, molecular and behavioral effects of interictal spiking in the rat

“…This is interesting in the context of reports showing that ADHD is frequently associated with epilepsy (Garcia-Morales et al 2008) and that interictal discharges are more common in children with ADHD than in normal children, even in the absence of clinical seizures (Richer et al 2002; Holtmann et al 2003; Becker et al 2004; Boutros et al 2005; Silvestri et al 2007; Fonseca et al 2008). Further evidence that interictal spiking has a direct effect on behavior comes from the observation that lateralization of interictal spiking was associated with asymmetric ambulation (rotations).…”

“…One possibility is that interictal spikes contribute to both epileptogenesis and behavioral comorbidities (Staley et al 2011). Interictal spikes have been observed in ADHD even without seizures (Richer et al 2002; Silvestri et al 2007; Fonseca et al 2008) and improved behavior is noted in patients with reduced interictal spiking (Pressler et al 2005). …”

Endogenous ACh effects on NMDA‐induced interictal‐like discharges along the septotemporal hippocampal axis of adult rats and their modulation by an early life generalized seizure

“…They may correspond to a transient cognitive impairment (Binnie, 2003; Pressler et al., 2005), they may be a driving force in activity‐dependent gene expression and plasticity at epileptic foci (Rakhade et al., 2007), or they may drive epileptogenesis (Staley et al., 2005). They have also been recorded in a wide range of behavioral and psychiatric disorders apart from epilepsy (Bridgers, 1987), including attention deficit (Richer et al., 2002; Silvestri et al., 2007; Fonseca et al., 2008), anxiety disorders, and psychoses (Inui et al., 1998; Pillmann et al., 1999). Their modulation may, therefore, have widespread implications.…”

Common psychiatric comorbidities in epilepsy: How big of a problem is it?

“…Several reports suggest that EEG abnormalities may be present in children with ADHD even without confirmed epilepsy (76,77). One report found that treatment with valproate improved paroxysmal EEG abnormalities as well as ADHD ratings (78).…”