The Challenge of Pharmacotherapy in Children and Adolescents with Epilepsy-ADHD Comorbidity

Abstract

Epilepsy is common in children and adolescents where its prevalence is 3.2-5.5/1000. About one-third of patients also have attention deficit hyperactivity/impulsivity disorder (ADHD). The possible relationship between epilepsy and ADHD is still unclear, and ADHD symptoms (such as inattention, hyperactivity, behavioral disturbances) are frequently considered as adverse effects of antiepileptic drugs (AEDs). The literature was searched for data on the behavioral effects of AEDs. Phenobarbital is the most frequently reported medication to induce symptoms of ADHD, followed by topiramate and valproic acid. Phenytoin seems to exert modest effects, while for levetiracetam there are contrasting data. Lacosamide induces some beneficial effects on behavior; carbamazepine and lamotrigine exert favorable effects on attention and behavior. Gabapentin and vigabatrin have limited adverse effects on cognition. Oxcarbazepine, rufinamide, and eslicarbazepine do not seem to aggravate or induce ADHD symptoms, whereas perampanel can lead to a high incidence of hostile/aggressive behavior, which increases with higher dosages. Information about the behavioral effects of ethosuximide, zonisamide, tiagabine, pregabalin, stiripentol, and retigabine is still limited. Because ADHD significantly affects the quality of life of epilepsy patients, the clinical management of this neuropsychiatric disorder should be a priority. Methylphenidate is effective most children and adolescents with ADHD symptoms and comorbid epilepsy, without a significant increase of seizure risk, although data are still limited with few controlled trials.

Role of NKCC1 and KCC2 in Epilepsy: From Expression to Function

“…Current AEDs enhance GABAergic function (18), either by modulating the post-synaptic GABAa Rs (barbiturates and benzodiazepines) or by acting on synaptic GABA availability (vigabatrin). The challenge faced by physicians is that conventional AEDs approved for use in adults have poor effects in neonates and may actually potentiate seizures in this patient population (19)(20)(21)(22). In this review, we introduce the main chloride transporters associated with GABA signaling and discuss their regulatory dynamics on GABA functions at various levels ranging from genotypes to functional alterations and phenotypes.…”

Medication treatment for attention‐deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy

“…Despite longstanding concerns regarding the safety of stimulant medication use in individuals with epilepsy, our results add to a growing body of research showing limited evidence for an exacerbated seizure risk associated with ADHD medications. Because ADHD can have a significant adverse impact on academic, social, and cognitive functioning, effective treatment of ADHD is crucial . Our findings suggest that epilepsy should not automatically preclude patients from receiving pharmacologic treatment for ADHD.…”

“…Because ADHD can have a significant adverse impact on academic, social, and cognitive functioning, effective treatment of ADHD is crucial. 19,42 Our findings suggest that epilepsy should not automatically preclude patients from receiving pharmacologic treatment for ADHD. and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.…”

Genetics and epigenetics of attention deficit hyperactivity disorder

“…Средняя частота обсессивно-компульсивных расстройств у больных СДВГ составляет 8%, что значительно выше, чем в популяции (2-3%), у больных с обсессивно-компульсивными расстройствами распространенность СДВГ составляет 17,1-25,5% [9]. Приблизительно у 1 / 3 больных эпилепсией наблюдается СДВГ [29].…”