Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges

Abstract

Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.

Is Electroencephalography Useful in Children with Developmental Delays but without Overt Seizures?

“…DD/ID and epilepsy are closely related, with increased rates of epilepsy observed in patients with DD. Numerous studies have reported a higher frequency of epilepsy co-occurring in children with neurodevelopmental disorders [19,20]. Additionally, individuals with neurodevelopmental conditions, such as ASD or ADHD and epilepsy, are more likely to display EEG abnormalities than their counterparts [21,22].…”

Frequently asked questions about adverse drug reactions of methylphenidate

“…A 2023 review investigated whether there is an increased risk of seizures for children with ADHD and epilepsy and found epidemiological data suggesting that the risk is not increased and may even be decreased with treatment with central stimulants. 17 A retrospective study with over 800 000 patients showed no difference in the risk of developing seizures with central stimulant treatment among patients with a history of seizures before treatment initiation. 18 In summary, methylphenidate should be used cautiously in epilepsy patients, but current data do not show an increased seizure risk.…”

Use of cannabidiol in the treatment of drug-refractory epilepsy in children and young adults: A systematic review

“…Epilepsy is among the neurological pathologies that most frequently affect pediatric and adolescent patients, accompanied by various psychological, behavioral, and cognitive comorbidities that profoundly impact the quality of life of the patients; [ 1 ] Among these, intellectual disability, attention deficit hyperactivity disorder, autism, anxiety, depression, and sleep disorders stand out. [ 2 ] The condition of epilepsy is characterized by the presence of irregular neuronal discharges or abnormal overexcitation of neurons with synchronization; it is classified into three subtypes: Acquired, idiopathic, and epilepsy of genetic origin with approximately 1000 linked genes. The essence of the pathology lies in the influence of inhibition through g-aminobutyric acid (GABA) as well as glutamate-mediated stimulation.…”