Attention Deficit Hyperactivity Disorder and Associated Cognitive Dysfunction in Pediatric Epilepsy

Onset of Inattention and Hyperactivity in Children and Adolescents With Epilepsy 6 months After the Diagnosis

OBJECTIVE

Complete or major symptoms of ADHD are often present in epilepsy. This study evaluated inattention and hyperactivity symptoms over the first 6 months in newly diagnosed pediatric epilepsy without comorbid ADHD.

METHOD

Children and adolescents with newly diagnosed epilepsy were followed for 6 months after starting antiseizure medications. The Nisonger Child Behavior Rating Form (NCBRF), Adverse Event Profile (AEP), and the Revised Wechsler Intelligence Scale for Children were used.

RESULTS

There was a marked increase in attention difficulties while a moderate increase in hyperactivity levels. AEP scores, changes in non-verbal aspects of intelligence, levels of hyperactivity at the follow-up, and attention at baseline were significant predictors for inattention. In contrast, only levels of hyperactivity at the baseline and inattention at the follow-up were significant predictors for hyperactivity.

CONCLUSION

Significant inattention and hyperactivity levels originated 6 months after the diagnosis of epilepsy and starting antiseizure medication.

Comorbidity of epilepsy and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis

Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are common neurological and neuropsychiatric disorders, respectively, that can exist as comorbidities. However, the degree of comorbidity between both disorders has never been quantified based on a systematic review with meta-analysis. We performed a systematic search of the literature in Embase, PubMed, PsychINFO and the Cochrane Library on June 20, 2022. In a meta-analysis of 63 studies with a total sample size of 1,073,188 individuals (172,206 with epilepsy and 900,982 with ADHD) from 17 countries, the pooled prevalence of ADHD in epilepsy was 22.3% (95% CI 20.3-24.4%). The highest pooled prevalence was 12.7% (95% CI 9-17.1%) for ADHD-I subtype, whereas the pooled prevalence of epilepsy in ADHD was 3.4% (95% CI 2.53-4.21%). However, substantial heterogeneity in comorbidity rates was observed and partially attributed to the following factors: sample size, sample specification, geographical variations and diagnostic methods. Our study highlights the need for increased awareness of this diagnostic co-occurrence, and research is warranted to elucidate the underlying pathophysiological mechanisms.

How have the recent updated epilepsy classifications impacted on diagnosis and treatment?

INTRODUCTION

Epilepsies are a diverse group of disorders which differ regarding prognosis for seizure control and associated comorbidities. Accurate classification is critical to choose the highest yield investigations and best therapeutic options and to provide the most accurate prognoses regarding the expected degree of seizure control, possible remission, and risk of associated comorbidities to patients and their families. This article reviews the recent updates in epilepsy classification to illustrate how accurate classification impacts care for persons with epilepsy.

AREAS COVERED

The authors discuss the ILAE 2017 Classification of the Epilepsies along with the modification of the classification for neonatal seizures and epilepsies. They also discuss the ILAE position papers on Epilepsy syndromes in neonates and infants and children of variable age and the Idiopathic Generalized Epilepsies.

EXPERT OPINION

Accurate epilepsy classification allows selection of the highest yield investigations, choice of optimal therapies, and accurate prognostication of seizures (likelihood of response to antiseizure treatments and likelihood of remission with age), as well as comorbidities (likelihood, type, and severity). As we move into the era of disease modifying therapy, early accurate identification of underlying causes with timely introduction of specific treatments will be crucial to lessen the severity of epilepsy, with improved seizure control and attenuation of associated comorbidities.

Disconnecting surgery at alveus and cornu ammonis of hippocampus, amygdala superficialis, and amygdala medial nuclei for epilepsy associated with attention deficit hyperactivity disorder

The neural basis for epilepsy and attention deficit hyperactivity disorder (ADHD) is currently incompletely known. We reported a young girl with both epilepsy and ADHD, who had a calcified lesion in the right basolateral amygdalo-hippocampal region extending to the ventral striatum. The child underwent disconnecting surgery and biopsy of the lesion. Fascinatingly, the child's behavior changed immediately after the surgery from inattentive and impulsive to nearly normal behavior experiencing no more breakthrough seizures since after 3 years of surgery. The Schaltenbrand Wahren Brain Atlas revealed alveus, cornu ammonis, amygdala superficialis, and medium as the disconnected region in this surgery.

Psychiatric and Nonpsychiatric Comorbidities Among Children With ADHD: An Exploratory Analysis of Nationwide Claims Data in Germany

Objective: This study examined the full spectrum of comorbid disorders in all statutory-health-insured children aged 5 to 14 years with ADHD in 2017 by using nationwide claims data in Germany. Method: Children with ADHD (n = 258,662) were compared for the presence of 864 comorbid diseases with a control group matched by gender, age, and region of residence (n = 2,327,958). Results: Among others, metabolic disorders (odds ratio [OR] = 9.18; 95% confidence interval [CI] = [8.43, 9.99]), viral pneumonia (OR = 4.95; 95% CI = [2.37, 10.33]), disorders of white blood cells (OR = 4.55; 95% CI = [3.83, 5.40]), kidney failure (OR = 3.33; 95% CI = [2.65, 4.18]), hypertension (OR = 3.26; 95% CI = [3.00, 3.55]), obesity (OR = 2.85; 95% CI = [2.80, 2.91]), type 2 diabetes (OR = 2.61; 95% CI = [2.11, 3.23]), migraine (OR = 2.49; 95% CI = [2.37, 2.61]), asthma (OR = 2.19; 95% CI = [2.16, 2.22]), atopic dermatitis (OR = 2.10; 95% CI = [2.16, 2.23]), juvenile arthritis (OR = 1.56; 95% CI = [1.39, 1.76]), glaucoma (OR = 1.51; 95% CI = [1.30, 1.75]), and type 1 diabetes (OR = 1.30; 95% CI = [1.20, 1.40]) were more likely to be diagnosed in ADHD children. Conclusion: Along with psychiatric diseases, various somatic diseases were more common in ADHD children. The results have direct implications for patient care, including fine-grained diagnostics and personalized therapy.

Parental report of quality of life in children with epilepsy: A Spanish/French comparison

BACKGROUND

Epilepsy is a chronic neurological condition that affects the quality of life (QoL) of patients and their families. In this study, we compare two sets of reports on QoL that were completed by two samples of parents whose children have epilepsy.

METHOD

Parents of children with various types of epilepsy from Spain (N = 196) and France (N = 219) completed the same QoL questionnaire. Medical variables were recorded from the referred specialist doctor for each patient.

RESULTS

The factors associated with parental reports on QoL were similar in both countries. Parents of children with nonidiopathic generalized or unclassified epilepsy reported poorer QoL and the highest proportion of learning and behavioral problems. However, the intensity of difficulties varied between the two samples.

CONCLUSIONS

This questionnaire made it possible to detect comorbidities and daily life difficulties in children with epilepsy and their families. The type of epilepsy had the same influence on Spanish and French families' ratings of QoL. Families shared the same comorbidities in terms of hyperactivity/attention/sociability problems. Nevertheless, the intensity of reported difficulties varied in both countries, possibly because of differences in cultural and educational environments. This aspect should be further explored in future research.

Long-Term Effects of Zinc Deficiency and Zinc Supplementation on Developmental Seizure-Induced Brain Damage and the Underlying GPR39/ZnT-3 and MBP Expression in the Hippocampus

We previously illustrated that long-term upregulated expression of ZnT-3 in the hippocampus of rats that underwent neonatal seizures was restored by pretreatment with a ketogenic diet. It was recently demonstrated that upregulated expression of ZnT-3 was associated with increased concentrations of intracellular free zinc ions in an in vitro model of glutamate-induced hippocampal neuronal excitotoxic damage. However, there is still a lack of research on the effects of different concentrations of zinc in the diet on developmental convulsive brain injury. The aim of this study was to investigate the effects of different zinc concentrations in the diet on long-term neurobehavioral and seizure thresholds following lithium chloride-pilocarpine-induced developmental seizures. Sprague-Dawley rats (postnatal day 27, P27) were randomly assigned to one of six dietary groups for 4 weeks: normal zinc control group (Control group, 44 mg/kg Zn), Zn-deficient control group (ZD group, 2.7 mg/kg Zn), Zn supplemented control group (ZS group, 246 mg/kg Zn), pilocarpine-induced seizure plus regular zinc diet group (SE group, 44 mg/kg Zn), seizure plus low-zinc diet group (SE + ZD group, 2.7 mg/kg Zn), and seizure plus high-zinc diet group (SE + ZS group, 246 mg/kg Zn). Novel object recognition and passive avoidance tests were performed on rats at P42 and P56. After routine seizure threshold detection and Timm staining procedures at P57, expression of GPR39, ZnT-3, and MBP were detected in the hippocampus by Western blot analysis. The results revealed that the Zinc-deficient diet for 4 weeks aggravated the long-term adverse effects of developmental seizures, evidenced by weight, cognition, seizure threshold and serum zinc concentrations, which were paralleled by expression changes in hippocampal GPR39 and ZnT-3. In contrast, zinc supplementation for 4 weeks significantly improved damage-related changes described above and rescued the abnormal expression of GPR39, ZnT-3, and MBP in the hippocampus. Similar alterations between the expression pattern of MBP and aberrant sprouting of mossy fibers in the hippocampus may indicate that sprouting is a secondary pathological change caused by developmental brain damage rather than the cause of epileptogenesis. Up-regulation of MBP protein levels in the high zinc diet-treated seizure group as well as the corresponding improvement of cognitive impairment and reduced hippocampal mossy fiber regenerative sprouting, may represent a compensatory mechanism for neuronal membrane damage and repair.