The Electroencephalogram in Attention Deficit–Hyperactivity Disorder: Emphasis on Epileptiform Discharges

Hughes, John R.; DeLeo, Andrea J.; Melyn, Michelle A.

doi:10.1006/ebeh.2000.0073

Cited by 97 publications

(49 citation statements)

References 25 publications

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“…In this retrospective study, the prevalence of EEG abnormalities among non-epileptic children with ADHD was 23.1%, which is similar to the average rate of eight studies (26.1%) summarized by Millichap et al [16] Compared to studies with awake only [15] or a lack of EEG studies, [13] the prevalence of EEG abnormalities in the current study is higher. However, the prevalence of abnormal EEG recordings in the current study is lower than that in studies with prolonged sleep recordings [20] or sleep-deprived EEGs [14,16]. This suggests that the prevalence of epileptiform discharges may be positively correlated with the duration of sleep EEG.…”

Section: Discussioncontrasting

confidence: 81%

“…Electroencephalography (EEG) has been used to evaluate electrical activity in the brain for some time, and several studies have demonstrated a high incidence of epileptic seizures and EEG abnormalities in children with ADHD [13][14][15][16][17]. Hemmer et al [13] reported the presence of epileptiform discharges in 36(15.4%) of 234 children with ADHD.…”

Section: Resultsmentioning

confidence: 99%

“…This is not surprising, since the amount of baseline brain rhythmicity differs considerably between sleep and wakefulness [31]. In a previous study, 24% of 176 children with ADHD showed focal paroxysmal abnormalities during sleep [14]. In addition, in the study by Silvestri et al [20] 53.1% of the children with ADHD had epileptiform discharges, mostly in the centrotemporal region, during polysomnography, compared with only 18.7% of children with ADHD with standard abnormal EEG recordings.…”

Section: Discussionmentioning

confidence: 95%

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Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Li¹,

Chen²,

Hung³

2018

Neuropsychiatry

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Objective: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood, however few studies have investigated epileptic seizures and electroencephalographic abnormalities in children with ADHD. The aim of this study was to explore the occurrence of epileptiform discharges in children with ADHD. Method:We enrolled children with ADHD who visited the neurology clinic of our hospital between January 2014 and June 2016, all of whom met the DSM-V criteria and underwent awake and sleep electroencephalography examinations. We excluded those with histories of intellectual disabilities, epilepsy, congenital anomalies and substance abuse. None of the patients had a history of seizures before the examination.Results: A total of 121 patients were included (93 males, 28 females, mean age 6.9±2.5 years), of whom 28 (23.1%) had electroencephalographic abnormalities, including three (10.7%) with generalized epileptiform discharges and 25 (89.3%) with focal epileptiform discharges. The focal epileptiform discharges were most prevalent from the rolandic area (15/25), followed by the parietal area (5/25), frontal area (4/25) and occipital area (1/25). Fourteen (50%) of the 28 patients had abnormal electroencephalographic findings only during sleep recordings. Conclusions:Electroencephalographic focal abnormalities were found in 23.1% of our patients, of which 50% appeared only during sleep recordings. We suggest that sleep and awake electroencephalography recordings should be part of the routine assessment of children with ADHD regardless of whether or not they have overt seizures or other neurological conditions. In patients who do not respond well to traditional ADHD drugs, treatment for paroxysmal electroencephalographic abnormalities may be considered.

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Section: Discussioncontrasting

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 95%

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Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Li¹,

Chen²,

Hung³

2018

Neuropsychiatry

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“…One prior report, which has not been replicated, identified positive spikes as a normal variant in children with ADHD, 14 which may explain the presence of increased theta/beta power ratios in these children.…”

Section: Recommendations For Future Researchmentioning

confidence: 93%

Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis

et al. 2016

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Objective: To evaluate the evidence for EEG theta/beta power ratio for diagnosing, or helping to diagnose, attention-deficit/hyperactivity disorder (ADHD). Methods:We identified relevant studies and classified them using American Academy of Neurology criteria.Results: Two Class I studies assessing the ability of EEG theta/beta power ratio and EEG frontal beta power to identify patients with ADHD correctly identified 166 of 185 participants. Both studies evaluated theta/beta power ratio and frontal beta power in suspected ADHD or in syndromes typically included in an ADHD differential diagnosis. A bivariate model combining the diagnostic studies shows that the combination of EEG frontal beta power and theta/beta power ratio has relatively high sensitivity and specificity but is insufficiently accurate. Conclusions:It is unknown whether a combination of standard clinical examination and EEG theta/ beta power ratio increases diagnostic certainty of ADHD compared with clinical examination alone.Recommendations: Level B: Clinicians should inform patients with suspected ADHD and their families that the combination of EEG theta/beta power ratio and frontal beta power should not replace a standard clinical evaluation. There is a risk for significant harm to patients from ADHD misdiagnosis because of the unacceptably high false-positive diagnostic rate of EEG theta/beta power ratio and frontal beta power. Level R: Clinicians should inform patients with suspected ADHD and their families that the EEG theta/beta power ratio should not be used to confirm an ADHD diagnosis or to support further testing after a clinical evaluation, unless such diagnostic assessments occur in a research setting. In 2013, the US Food and Drug Administration (FDA) approved the Neuropsychiatric EEG-Based ADHD Assessment Aid (NEBA), stating that the NEBA "uses the theta/beta ratio of the EEG measured at electrode CZ on a patient 6-17 years of age combined with a clinician's evaluation to aid in the diagnosis of ADHD" and "should only be used by a clinician as confirmatory support for a completed clinical evaluation or as support for the clinician's decision to pursue further testing following a clinical evaluation."1 The FDA further stated that "(t)he device is NOT to be used as a stand-alone in the evaluation or diagnosis of ADHD." The NEBA calculates the ratio of the power of the EEG theta and beta bands at Cz, which is the EEG electrode halfway between the inion and the nasion.Individuals with attention-deficit/hyperactivity disorder (ADHD) demonstrate a persistent pattern of inattention or hyperactivity/impulsivity, or both, that interferes with functioning and is inappropriate for developmental age. ADHD is typically diagnosed with a clinical examination. Appendix e-1 at Neurology.org presents the DSM-5 clinical criteria used for ADHD diagnosis.2 The American Academy of Pediatrics clinical practice guideline for the diagnosis, evaluation, and treatment of ADHD in children and adolescents provides a strong recommendation that when asses...

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“…Um estudo que comparou crianças com TDAH e espículas rolândicas pareadas quanto a sexo, idade e quociente de inteligência com crianças com TDAH e EEG normal evidenciou que a presença dessas anormalidades eletroencefalográficas esteve associada com um curso mais grave dos sintomas de TDAH e uma maior predisposição à impulsividade 26 . Hughes et al 32 encontraram anormalidades epileptiformes em 30% dos pacientes com TDAH de sua casuística, e essa elevada estatística certamente se deve à inclusão de registros eletroencefalográficos feitos durante o sono. Estudos com polissonografia realizados em 44 crianças portadoras de TDAH detectaram descargas epileptiformes interictais subclínicas em 53,1% -28,2% apresentavam descargas centrotemporais, 12,5%, frontais, 9,3%, descargas têmporo-occipitais e 2,3%, atividade epileptiforme tipo ponta-onda generalizada.…”

Section: ) Qual é a Relevância Dos Achados Eletroencefalográficos Nounclassified

Possíveis interfaces entre TDAH e epilepsia

Loutfi

Carvalho²

2010

J. bras. psiquiatr.

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reSumo objetivo: Identificar na literatura elementos para explicar uma possível associação entre o transtorno de déficit de atenção e hiperatividade (TDAH) e a epilepsia e orientar quanto ao manejo clínico dos pacientes que compartilham esses transtornos. métodos: Realizou-se revisão da literatura dos últimos 10 anos nas bases de dados MedLine e Lilacs com a combinação dos descritores "attention deficit hyperactivity disorder", "ADHD" e "epilepsy". resultados: Sintomas de TDAH são frequentes em síndromes epilépticas idiopáticas. Vários fatores podem contribuir para a coexistência desses transtornos: 1) possibilidade de uma mesma propensão genética; 2) participação dos neurotransmissores noradrenalina e dopamina no TDAH e na modulação da excitabilidade neuronal; 3) anormalidades estruturais do cérebro evidenciadas em epilépticos portadores de TDAH; 4) influência dos efeitos crônicos das crises e das descargas epileptiformes interictais sob a atenção; 5) efeitos adversos das drogas antiepilépticas sob a cognição. conclusões: As evidências atuais apontam que crises epilépticas e TDAH podem apresentar bases neurobiológicas comuns. Estudos que avaliam disfunções nas vias de sinalização das catecolaminas cerebrais e o papel das descargas epileptiformes interictais na geração dos sintomas são fundamentais na investigação desses mecanismos. Drogas psicoestimulantes são seguras e eficazes para o tratamento do TDAH na maioria dos portadores de epilepsia.

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The Electroencephalogram in Attention Deficit–Hyperactivity Disorder: Emphasis on Epileptiform Discharges

Cited by 97 publications

References 25 publications

Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis

Possíveis interfaces entre TDAH e epilepsia

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