The Utility of EEG in Attention Deficit Hyperactivity Disorder: A Replication Study

Abstract

The routine use of stimulants in pediatrics has increased dramatically over the past 3 decades and the long-term consequences have yet to be fully studied. Since 1978 there have been 7 articles identifying electroencephalogram (EEG) abnormalities, particularly epileptiform discharges in children with attention deficit hyperactivity disorder (ADHD). Many have studied the prevalence of these discharges in this population with varying results. An article published in 2011 suggests that EEG technology should be considered prior to prescribing stimulants to children diagnosed with ADHD due to a high prevalence of epileptiform discharges. The 2011 study found a higher prevalence (26%) of epileptiform discharges when using 23-hour and sleep-deprived EEGs in comparison with other methods of activation (hyperventilation or photostimulation) and conventional EEG. We sought to replicate the 2011 results using conventional EEG with the added qEEG technologies of automatic spike detection and low-resolution electromagnetic tomography analysis (LORETA) brain mapping. Our results showed 32% prevalence of epileptiform discharges, which suggests that an EEG should be considered prior to prescribing stimulant medications.

Proceedings of the 2020 ISNR Annual Conference: Keynote and Plenary Sessions

“…They found high rates of IEDs have been found in specific diagnostic categories such as panic and anxiety disorders, mood disorders, schizophrenia, eating disorders, personality disorders, and violent behavior. Additionally, high rates of IEDs have been found specific to childhood disorders such as ADHD (Kanazawa, 2014;Lee, Choi, Yoon, & Bahn, 2015;Milichap, Stack, & Millichap, 2011;Swatzyna, Tarnow, Roark, & Mardick, 2017a) and Autism Spectrum Disorder (Chez et al, 2006;Mulligan & Trauner, 2013;Reinhold, Molloy, & Manning-Courtney, 2005;Swatzyna 2017b;Yasuhara, 2010). We present the findings of our systematic review of the literature and compare them to our crosssectional analysis in order to determine prevalence rates of IEDs within diagnostic categories.…”

Electroencephalography in the diagnosis and management of treatment-resistant depression with comorbid epilepsy: a novel strategy

“…If administered oblivious to the possibility of concomitant subtle seizures, these medications may precipitate a frank epileptic attack (for which neither the patients nor the clinicians may be prepared) and cause worsening of the depressive state. In managing patients with attention deficit hyperactivity disorder (ADHD), several researchers have observed that the removal of medication that lowers seizure threshold coupled with the addition of an anticonvulsant has resulted in outcomes based on which they have recommended stabilisation of IEDs to ensure effective therapy,40 41 thus underscoring the utility of an EEG. In accordance with evidence from the same studies on ADHD,40 41 the author opines that the failure of antidepressants in a significant number of patients with depression could be due to a possibility of concomitant undetected epilepsy or IEDs that can also contribute to the symptomatology of depression, in which case the utility of an EEG cannot be overemphasised.…”

“…In managing patients with attention deficit hyperactivity disorder (ADHD), several researchers have observed that the removal of medication that lowers seizure threshold coupled with the addition of an anticonvulsant has resulted in outcomes based on which they have recommended stabilisation of IEDs to ensure effective therapy,40 41 thus underscoring the utility of an EEG. In accordance with evidence from the same studies on ADHD,40 41 the author opines that the failure of antidepressants in a significant number of patients with depression could be due to a possibility of concomitant undetected epilepsy or IEDs that can also contribute to the symptomatology of depression, in which case the utility of an EEG cannot be overemphasised. Thus, in patients with depression with IEDs, stabilisation of IEDs by an antiepileptic can function as a priming effect for antidepressants.…”

Retrospective Analysis of Nonepileptic Patients With Isolated Epileptiform Discharges Treated With Anticonvulsants

“…In past research, IEDs have been found to be highly prevalent in certain psychiatric populations. For example, Millichap et al, 13 and Swatzyna et al 14 found a high prevalence of IEDs in ADHD patients.…”

“…IEDs represent a dysregulated focus isolated to one part of the brain that is not likely to develop into a seizure focus but would possibly respond well to an AED intervention. It has been suggested that AEDs be considered when IEDs have been identified, 13,14,20 but there is a paucity of research to confirm this.…”