What are the challenges with the pharmacological management of epilepsy in patients with Attention Deficit Hyperactivity Disorder (ADHD)?

Matricardi, Sara; Farello, Giovanni; Operto, Francesca Felicia; Coppola, Giangennaro

doi:10.1080/14656566.2020.1732351

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…In the present study, a strong negative correlation between IQ level and both duration of epilepsy and seizure frequency/month was observed, and this study is in agreement with Matricardi et al (32) . Also a study reported a negative correlation between duration of epilepsy cognitive function and increased frequency of seizures associated with cognitive impairment (CI) (33) .…”

Section: Discussionsupporting

confidence: 94%

Clinical Profile and Comorbidity of Epilepsy in El Minia, Egypt: A Hospital-Based Study

Zydan¹,

eldeen²,

Abo-Elkheir³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: Classifying epileptic cases based on in-depth study and analyzing groups of different ages and gender can enhance the accuracy of diagnosing epileptic patients.Objective: This research aimed to identify the different clinical profiles of epilepsy and its comorbid disorders. Methods: A one-year hospital-based cross-sectional study conducted on hundreds of epileptic patients including a detailed history, clinical examination, electroencephalography (EEG), neuroimaging (MRI), and psychometric assessment. Results: There were two groups including 56.0% males and 44 % females. 83.5% of patients were rural residents. Generalized onset seizures were 73.5%, focal-onset seizures reported 20.5% and 6.0% unknown type. Abnormal EEG occurred in 77.5% and 22.5% of patients showed abnormal neuroimaging findings. Structural causes of epilepsy were recorded in only 20.5%. Monotherapy was applied to 80.5% and 19.0% received polytherapy. The treatment gap was reported at 17% with a significant statistical difference between age groups. Attention-deficit hyperactivity disorder (ADHD) was recorded in 15.0%, migraine was reported in 12.0%, cerebral palsy (CP) was recorded in 7.5%, and intellectual disability was reported in 3.0%. A significant negative correlation between the IQ level and both duration of epilepsy and seizure frequency/month was reported. Furthermore, a significant positive correlation was reported between the duration of epilepsy and seizure frequency/month. Conclusion: Epilepsy is characteristic in our patients and shows age and sex differences in terms of many features. Most of the patients were receiving monotherapy. There were patients with a positive treatment gap, ADHD, and intellectual disability (ID). Structural causes of epilepsy were recorded among more than a fifth of patients.

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Section: Discussionsupporting

confidence: 94%

Clinical Profile and Comorbidity of Epilepsy in El Minia, Egypt: A Hospital-Based Study

Zydan¹,

eldeen²,

Abo-Elkheir³

et al. 2022

The Egyptian Journal of Hospital Medicine

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“…For the most ASMs, remarkably few studies providing robust data on the psychiatric adverse effects in epileptic patients were identified. Barbiturates, Topiramate, Valproate, and Zonisamide have been reported to cause worsening attention ( 102 , 103 ). Phenobarbital, vigabatrin, zonisamide, topiramate, and levetiracetam could be associated with depression ( 102 ).…”

Section: Diagnosis and Pharmacological Management Of Psychiatric Comorbiditymentioning

confidence: 99%

Temporal Lobe Epilepsy and Psychiatric Comorbidity

et al. 2021

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Most focal seizures originate in the temporal lobe and are commonly divided into mesial and lateral temporal epilepsy, depending upon the neuronal circuitry involved. The hallmark features of the mesial temporal epilepsy are aura, unconsciousness, and automatisms. Symptoms often overlap with the lateral temporal epilepsy. However, the latter present a less evident psychomotor arrest, frequent clones and dystonic postures, and common focal to bilateral tonic–clonic seizures. Sclerosis of the hippocampus is the most frequent cause of temporal lobe epilepsy (TLE). TLE is among all epilepsies the most frequently associated with psychiatric comorbidity. Anxiety, depression, and interictal dysphoria are recurrent psychiatric disorders in pediatric patients with TLE. In addition, these alterations are often combined with cognitive, learning, and behavioral impairment. These comorbidities occur more frequently in TLE with hippocampal sclerosis and with pharmacoresistance. According to the bidirectional hypothesis, the close relationship between TLE and psychiatric features should lead to considering common pathophysiology underlying these disorders. Psychiatric comorbidities considerably reduce the quality of life of these children and their families. Thus, early detection and appropriate management and therapeutic strategies could improve the prognosis of these patients. The aim of this review is to analyze TLE correlation with psychiatric disorders and its underlying conditions.

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“…Not surprisingly Lennox-Gastaut syndrome (LGS), Dravet Syndrome (DS), early infantile epileptic encephalopathy or Rasmussen encephalitis are almost pharmacoresistant ( Dalic and Cook 2016 ). Also the coexistence of neuropsychiatric disorders such as intellectual disability or Attention Deficit Hyperactivity Disorder (ADHD) is related to the risk of DRE ( Matricardi et al, 2020 ). Other risk factors include a history of febrile seizure, status epilepticus, abnormal EEG, abnormal neuroimaging test results ( Kalilani et al, 2018 ) or an inadequate response to the initial ASM therapy and time to achieving seizure freedom ( Kwan and Brodie 2000 ; Schmidt 2007 ).…”

Section: Introductionmentioning

confidence: 99%

Improving Therapy of Pharmacoresistant Epilepsies: The Role of Fenfluramine

et al. 2022

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Epilepsy is among the most common neurological chronic disorders, with a prevalence of 0.5–1%. Despite the introduction of new antiepileptic drugs during recent years, about one third of the epileptic population remain drug-resistant. Hence, especially in the pediatric population limited by different pharmacokinetics and pharmacodynamics and by ethical and regulatory issues it is needed to identify new therapeutic resources. New molecules initially used with other therapeutic indications, such as fenfluramine, are being considered for the treatment of pharmacoresistant epilepsies, including Dravet Syndrome (DS) and Lennox-Gastaut Syndrome (LGS). Drug-refractory seizures are a hallmark of both these conditions and their treatment remains a major challenge. Fenfluramine is an amphetamine derivative that was previously approved as a weight loss drug and later withdrawn when major cardiac adverse events were reported. However, a new role of fenfluramine has emerged in recent years. Indeed, fenfluramine has proved to be a promising antiepileptic drug with a favorable risk–benefit profile for the treatment of DS, LGS and possibly other drug-resistant epileptic syndromes. The mechanism by which fenfluramine provide an antiepileptic action is not fully understood but it seems to go beyond its pro-serotoninergic activity. This review aims to provide a comprehensive analysis of the literature, including ongoing trials, regarding the efficacy and safety of fenfluramine as adjunctive treatment of pharmacoresistant epilepsies.

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What are the challenges with the pharmacological management of epilepsy in patients with Attention Deficit Hyperactivity Disorder (ADHD)?

Cited by 9 publications

References 13 publications

Clinical Profile and Comorbidity of Epilepsy in El Minia, Egypt: A Hospital-Based Study

Clinical Profile and Comorbidity of Epilepsy in El Minia, Egypt: A Hospital-Based Study

Temporal Lobe Epilepsy and Psychiatric Comorbidity

Improving Therapy of Pharmacoresistant Epilepsies: The Role of Fenfluramine

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