Attention Deficit Hyperactivity Disorder (ADHD) Symptoms in Children With Epilepsy

Epilepsy may be defined as the recurrence of apparently spontaneous seizures and can be a pervasive condition in which the seizures are just one expression Epileptic seizures are transient clinical events resulting from atypical and excessive activity of more or less widespread population of cerebral neurons Epilepsy is a heterogeneous disorder that consists of clinical syndromes, characterized by different types of seizures, and underlying aetiologies . It is the most common pediatric neurological disorder with prevalence estimates of 0.5-1% of all children from birth to 16 years .

Attention deficit/hyperactivity disorder (ADHD) is a common brain disorder with onset in early childhood,due to structural and functional abnormalities in widespread, but specific areas of the brain . ADHD is a frequent co morbidity experienced by children with epilepsy, has a negative impact on their quality of life,and represents a significant risk factor for academic underachievement.

ADHD has been reported in epilepsy since the Fifties of the 20th century .More recently a high association between the two disorders, with an increasing evidence of a bidirectional relationship, has been postulated . Several factors may contribute to this comorbidity, including the underlying brain pathology, the chronic effects of seizures and of the epileptiform EEG discharges, and the effects of antiepileptic drugs. Symptoms of ADHD are more common in some specific types of epilepsies, such as frontal lobe epilepsy, childhood absence epilepsy and Rolandic epilepsy, and may antedate seizure onset in a significant proportion of cases.

Attention problems are frequently reported in children with intractable symptomatic epilepsy, as well as in idiopathic epilepsies . Patients who have generalized epilepsies are more frequently reported to have attentional difficulties than patients suffering from partial seizures. Furthermore, certain epilepsy syndromes may predispose to ADHD-like behavior .ADHD is a prevalent co morbidity of new onset idiopathic epilepsy, associated with a series of cognitive and behavioral complications that antedate epilepsy onset in a significant proportion of cases, and appear related to neurodevelopmental abnormalities in brain structures . The presence of ADHD symptoms at the time of epilepsy onset is a major marker of abnormal cognitive development The mechanisms underlying attention deficits are still unknown and appear to be different between focal and generalized epilepsies. In the clinical practice, this association may represent a challenge for child neurologists since antiepileptic therapy and drugs used to treat ADHD may aggravate the clinical picture of each other .-Treatment with psychotropic drugs can be initiated safely in most children with epilepsy and ADHD symptoms.

Previous studies show that Children with epilepsy have more attention problems as compared with healthy controls. ADHD in childhood epilepsy is associated with male sex, younger age, early first onset age, high frequency of epileptic seizures, and multiple AEDs