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Gopaul M, Altalib H. Do psychotropic drugs cause seizures? Epilepsy Behav Rep 2024; 27:100679. [PMID: 38881884 PMCID: PMC11179069 DOI: 10.1016/j.ebr.2024.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
Patients with epilepsy often present with concurrent psychiatric disorders, posing unique challenges for healthcare providers. This review explores the intricate relationship between psychiatric comorbidities, epilepsy, and psychotropic medications to inform clinical decision-making. The bidirectional association between epilepsy and psychiatric conditions complicates treatment, with psychiatric symptoms preceding or following seizure onset. The review discusses the seizure risks associated with antidepressants, CNS stimulants, and antipsychotics, shedding light on both historical perspectives and recent empirical evidence. Antidepressants, particularly tricyclic antidepressants (TCAs), are known to pose seizure risks, while newer agents like selective serotonin reuptake inhibitors (SSRIs) exhibit lower incidences and even potential anticonvulsant effects. Contrary to common beliefs, CNS stimulants used in attention-deficit/hyperactivity disorder (ADHD) treatment show efficacy without significantly increasing seizure risk. However, the association between ADHD and seizures warrants careful consideration. Among antipsychotics, clozapine stands out for its heightened seizure risks, especially during titration and at high doses, necessitating close monitoring and individualized approaches. Understanding the nuanced seizure risks associated with different psychotropic medications is crucial for optimizing patient care and minimizing iatrogenic seizures in this vulnerable population. By recognizing the complexities of psychiatric comorbidities in epilepsy and considering the unique challenges they pose, healthcare providers can make informed decisions to enhance patient safety and treatment outcomes. This review offers practical insights to guide clinicians in navigating the intricate landscape of managing psychiatric comorbidities in patients with epilepsy.
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Affiliation(s)
- Margaret Gopaul
- Yale Comprehensive Epilepsy Center, Dept. of Neurology, Yale University School of Medicine New Haven, CT, USA
- Veteran Administration (VA) Epilepsy Center of Excellence in West Haven, CT, USA
| | - Hamada Altalib
- Yale Comprehensive Epilepsy Center, Dept. of Neurology, Yale University School of Medicine New Haven, CT, USA
- Veteran Administration (VA) Epilepsy Center of Excellence in West Haven, CT, USA
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Baweja R, Baweja R, Weidlich H, Nyland JE, Waschbusch DA, Waxmonsky JG. Treatment Utilization Pattern of Preschool Children With Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2024; 28:708-721. [PMID: 38084067 DOI: 10.1177/10870547231215287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to identify patterns of ADHD care, including factors that guide selection and sequencing of treatments in a large nationwide sample of preschool-aged youth over the past 6 years. METHOD A retrospective cohort study utilizing a large electronic health record (TriNetX) of nearly 24,000 children ages 3 to 6 diagnosed with ADHD. RESULTS One in three preschoolers with ADHD were prescribed psychotropic medication, most commonly methylphenidate and guanfacine. One in 10 had at least one psychotherapy billing code during the entire assessment with most youth starting medication before psychotherapy. Rates of most treatments, including polypharmacy, increased with comorbid psychiatric disorders or sleep problems and over the course of the coronavirus pandemic. CONCLUSION Rates of treatment have increased over time but are still largely inconsistent with published care guidelines that advise therapy before medication. Clinicians appear to prioritize psychiatric comorbidity and sleep problems when selecting treatments.
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Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Ritika Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
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Checa-Ros A, Muñoz-Hoyos A, Molina-Carballo A, Viejo-Boyano I, Chacín M, Bermúdez V, D'Marco L. Low Doses of Melatonin to Improve Sleep in Children with ADHD: An Open-Label Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1121. [PMID: 37508618 PMCID: PMC10378280 DOI: 10.3390/children10071121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Only a few studies assessing the sleep effects of low doses of melatonin (aMT) have been performed in the past, most of them in adults, and only one in subjects with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to provide evidence of the changes induced by aMT doses as low as 1 mg in the sleep pattern of pediatric patients with ADHD under treatment with methylphenidate (MPH). METHODS Children and adolescents (7-15 years) with ADHD who were receiving extended-release MPH were recruited. A seven-week sleep diary was collected prior to starting a four-week treatment with 1 mg of aMT (30 min before bedtime). Seven-day actigraphic assessments of sleep were performed before and after treatment. RESULTS Twenty-seven patients (17 males, 62.96%) participated in the study, who had been receiving MPH for 1.57 (1.11) months. A significant increase in sleep duration (TST) was observed after one month of treatment (463 (49) min to 485 (41) min; p < 0.040), with nonsignificant improvements in sleep-onset latency (SOL), nocturnal awakenings, or sleep efficiency. Only minor adverse effects were reported. CONCLUSION Low doses of melatonin (1 mg) are able to increase TST in children and adolescents with ADHD receiving treatment with psychostimulants, with an adequate tolerability profile. Further placebo-controlled trials adjusting the time of aMT administration to the individual circadian profile should explore the effects of low doses of this hormone to shorten SOL in this population of patients.
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Affiliation(s)
- Ana Checa-Ros
- Grupo de Investigación en Enfermedades Cardiorrenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Santiago Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain
- Aston Institute of Health & Neurodevelopment, School of Life & Health Sciences, Aston University, The Aston Triangle, Birmingham B4 7ET, UK
| | - Antonio Muñoz-Hoyos
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Avda. De La Investigación 11, 18016 Granada, Spain
| | - Antonio Molina-Carballo
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Avda. De La Investigación 11, 18016 Granada, Spain
| | - Iris Viejo-Boyano
- Departamento de Nefrología, Hospital Universitari I Politècnic La Fe, Avda. Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Maricarmen Chacín
- Facultad de Ciencias de la Salud. Barranquilla, Universidad Simón Bolívar, Barranquilla 080002, Colombia
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud. Barranquilla, Universidad Simón Bolívar, Barranquilla 080002, Colombia
| | - Luis D'Marco
- Grupo de Investigación en Enfermedades Cardiorrenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Santiago Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain
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Fan HC, Chiang KL, Chang KH, Chen CM, Tsai JD. Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges. Int J Mol Sci 2023; 24:ijms24065270. [PMID: 36982345 PMCID: PMC10049646 DOI: 10.3390/ijms24065270] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, Hungkuang University, Taichung 433, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
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Maximizing Quality of Life in Children with Epilepsy. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010065. [PMID: 36670616 PMCID: PMC9863253 DOI: 10.3390/children10010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022]
Abstract
Arguably significant progress and improvement in the medical and surgical treatments of seizures and epilepsy in children have occurred; however, there have been relatively fewer efforts in optimizing the care of lifestyle complications related to the disease state. Many patients have significant behavioral and mental health comorbidities, including ADHD (attention deficit hyperactivity disorder), which should be treated. After epilepsy surgery, only seizure freedom results in improved quality of life (QOL). Improved compliance leads to better seizure control and ensuring that caregivers have a rescue treatment helps empower patients. Education and improving seizure illness perception is beneficial. Cannabidiol may have benefits other than seizure control. The majority of children are mainly concerned about the stigma attached to having epilepsy. Driving affecting older children is discussed. Restrictions on these children should be minimized and enabling regular activities maximized.
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Eaton C, Yong K, Walter V, Mbizvo GK, Rhodes S, Chin RF. Stimulant and non-stimulant drug therapy for people with attention deficit hyperactivity disorder and epilepsy. Cochrane Database Syst Rev 2022; 7:CD013136. [PMID: 35844168 PMCID: PMC9289704 DOI: 10.1002/14651858.cd013136.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) can co-occur in up to 40% of people with epilepsy. There is debate about the efficacy and tolerability of stimulant and non-stimulant drugs used to treat people with ADHD and co-occurring epilepsy. OBJECTIVES To assess the effect of stimulant and non-stimulant drugs on children and adults with ADHD and co-occurring epilepsy in terms of seizure frequency and drug withdrawal rates (primary objectives), as well as seizure severity, ADHD symptoms, cognitive state, general behaviour, quality of life, and adverse effects profile (secondary objectives). SEARCH METHODS We searched the following databases on 12 October 2020: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to 9 October 2020), CINAHL Plus (EBSCOhost, 1937 onwards). There were no language restrictions. CRS Web includes randomised or quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialised Registers of Cochrane Review Groups including Epilepsy. SELECTION CRITERIA: We included randomised controlled trials of stimulant and non-stimulant drugs for people of any age, gender or ethnicity with ADHD and co-occurring epilepsy. DATA COLLECTION AND ANALYSIS We selected articles and extracted data according to predefined criteria. We conducted primary analysis on an intention-to-treat basis. We presented outcomes as risk ratios (RRs) with 95% confidence intervals (CIs), except for individual adverse effects where we quoted 99% CIs. We conducted best- and worst-case sensitivity analyses to deal with missing data. We carried out a risk of bias assessment for each included study using the Cochrane risk of bias tool and assessed the overall certainty of evidence using the GRADE approach. MAIN RESULTS We identified two studies that matched our inclusion criteria: a USA study compared different doses of the stimulant drug osmotic-release oral system methylphenidate (OROS-MPH) with a placebo in 33 children (mean age 10.5 ± 3.0 years), and an Iranian study compared the non-stimulant drug omega-3 taken in conjunction with risperidone and usual anti-seizure medication (ASM) with risperidone and ASM only in 61 children (mean age 9.24 ± 0.15 years). All children were diagnosed with epilepsy and ADHD according to International League Against Epilepsy and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria, respectively. We assessed both studies to be at low risk of detection and reporting biases, but assessments varied from low to high risk of bias for all other domains. OROS-MPH No participant taking OROS-MPH experienced significant worsening of epilepsy, defined as: 1. a doubling of the highest 14-day or highest two-day seizure rate observed during the 12 months before the trial; 2. a generalised tonic-clonic seizure if none had been experienced in the previous two years; or 3. a clinically meaningful intensification in seizure duration or severity (33 participants, 1 study; low-certainty evidence). However, higher doses of OROS-MPH predicted an increased daily risk of a seizure (P < 0.001; 33 participants, 1 study; low-certainty evidence). OROS-MPH had a larger proportion of participants receiving 'much improved' or 'very much improved' scores for ADHD symptoms on the Clinical Global Impressions for ADHD-Improvement tool (33 participants, 1 study; low-certainty evidence). OROS-MPH also had a larger proportion of people withdrawing from treatment (RR 2.80; 95% CI 1.14 to 6.89; 33 participants, 1 study; moderate-certainty evidence). Omega-3 Omega-3 with risperidone and ASM were associated with a reduction in mean seizure frequency by 6.6 seizures per month (95% CI 4.24 to 8.96; 56 participants, 1 study; low-certainty evidence) and an increase in the proportion of people achieving 50% or greater reduction in monthly seizure frequency (RR 2.79, 95% CI 0.84 to 9.24; 56 participants, 1 study; low-certainty evidence) compared to people on risperidone and ASM alone. Omega-3 with risperidone and ASM also had a smaller proportion of people withdrawing from treatment (RR 0.65, 95% CI 0.12 to 3.59; 61 participants, 1 study; low-certainty evidence) but a larger proportion of people experiencing adverse drug events (RR 1.40, 95% CI 0.44 to 4.42; 56 participants, 1 study; low-certainty evidence) compared to people on risperidone and ASM alone. AUTHORS' CONCLUSIONS In children with a dual-diagnosis of epilepsy and ADHD, there is some evidence that use of the stimulant drug OROS-MPH is not associated with significant worsening of epilepsy, but higher doses of it may be associated with increased daily risk of seizures; the evidence is of low-certainty. OROS-MPH is also associated with improvement in ADHD symptoms. However, this treatment was also associated with a large proportion of treatment withdrawal compared to placebo. In relation to the non-stimulant drug omega-3, there is some evidence for reduction in seizure frequency in children who are also on risperidone and ASM, compared to children who are on risperidone and ASM alone. Evidence is inconclusive whether omega-3 increases or decreases the risk of adverse drug events. We identified only two studies - one each for OROS-MPH and omega-3 - with low to high risk of bias. We assessed the overall certainty of evidence for the outcomes of both OROS-MPH and omega-3 as low to moderate. More studies are needed. Future studies should include: 1. adult participants; 2. a wider variety of stimulant and non-stimulant drugs, such as amphetamines and atomoxetine, respectively; and 3. additional important outcomes, such as seizure-related hospitalisations and quality of life. Clusters of studies which assess the same drug - and those that build upon the evidence base presented in this review on OROS-MPH and omega-3 - are needed to allow for meta-analysis of outcomes.
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Affiliation(s)
- Chris Eaton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Kenneith Yong
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Victoria Walter
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Sinead Rhodes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Richard Fm Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Ahmed GK, Darwish AM, Khalifa H, Haridy NA. Relationship between Attention Deficit Hyperactivity Disorder and epilepsy: a literature review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00482-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurological disorder. ADHD has been linked to epilepsy.
Main body
ADHD was found to be present in 30–40% of epileptic children. Researchers have developed numerous theories to explain how and why ADHD and epilepsy coexist. Whether ADHD and epilepsy symptoms are caused by co-occurring psychiatric disorders or by the temporary effects of epileptic discharges or by antiepileptic medicines is critical to consider. Diagnosis and treatment of individuals with ADHD and epilepsy are complicated and challenging from the clinical base.
Conclusions
Comorbidity between ADHD and epilepsy is still challenging to understand. The two diseases have a bidirectional link, so the association may not be coincidental. A disputable point is whether co-occurring ADHD and epilepsy symptoms represent a comorbid psychiatric disorder or are the epileptic discharges’ temporary effects, and are they related to antiepileptic drugs (AEDs). It is recommended to follow up with children with epilepsy or ADHD as they may develop comorbidity after a while.
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Yamamoto H, Nakagawa E, Kita Y, Kaga Y, Inagaki M. Effect of anti-attention-deficit hyperactivity disorder (ADHD) medication on clinical seizures and sleep EEG: A retrospective study of Japanese children with ADHD. Neuropsychopharmacol Rep 2021; 41:511-521. [PMID: 34668641 PMCID: PMC8698674 DOI: 10.1002/npr2.12215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022] Open
Abstract
Aims Patients with attention‐deficit hyperactivity disorder (ADHD) often exhibit basic or paroxysmal wave abnormalities on electroencephalography (EEG). Methylphenidate (MPH), an anti‐ADHD stimulant, has been reported to lower the seizure threshold. However, there have been no reports comparing EEG changes before and after administration of the central nervous system (CNS) stimulant MPH, or atomoxetine (ATX) hydrochloride, a non‐CNS stimulant. In this study, we investigated changes in sleep EEG before and after the administration of ADHD treatment drugs. Method With the approval of the ethics committee, the medical records of 28 children with ADHD (23 men and 5 women) who gave consent were retrospectively investigated. The appearance of sudden abnormal waves during a 10‐minute sleep EEG recording was measured in 0.1‐second units, and the duration of these waves was calculated as the paroxysmal index (PI). Results Paroxysmal index did not differ significantly between patients who received MPH and those who received ATX. In addition, there were no exacerbations of clinical seizures. Conclusion It was concluded that ADHD medications do not have an adverse effect on epileptic seizures or abnormal sleep EEGs. Patients with attention‐deficit hyperactivity disorder (ADHD) often exhibit basic or paroxysmal wave abnormalities on electroencephalography (EEG). We investigated changes in sleep EEG before and after the administration of ADHD treatment drugs. ADHD medications do not have an adverse effect on epileptic seizures or abnormal sleep EEGs.![]()
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Affiliation(s)
- Hisako Yamamoto
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira, Japan.,Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira, Japan
| | - Yousuke Kita
- Mori Arinori Center for Higher Education and Global Mobility, Hitotsubashi University, Tokyo, Japan.,Cognitive Brain Research Unit (CBRU), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Yoshimi Kaga
- Department of Developmental Disorders, National Institute of Mental Health, NCNP, Kodaira, Japan.,Department of Pediatrics, Faculty of Medicine, Yamanashi University, Yamanashi, Japan
| | - Masumi Inagaki
- Department of Developmental Disorders, National Institute of Mental Health, NCNP, Kodaira, Japan
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Detyniecki K. Do Psychotropic Drugs Cause Epileptic Seizures? A Review of the Available Evidence. Curr Top Behav Neurosci 2021; 55:267-279. [PMID: 34241816 DOI: 10.1007/7854_2021_226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Psychiatric comorbidities in patients with epilepsy are common. A bidirectional relationship has been well described where not only patients with epilepsy have a higher prevalence of psychiatric comorbidities but also patients with primary psychiatric disorders are at an increased risk of developing seizures. The aim of this review is to highlight the complex relationship between epilepsy and common psychiatric disorders and to answer the question whether psychotropic medications are proconvulsant by reviewing the preclinical and clinical literature. The evidence shows that the majority of psychotropic medications are not proconvulsant when used in therapeutic doses with the exception of a subset of medications, mainly bupropion IR and certain antipsychotic drugs such as clozapine. An effective treatment of psychiatric comorbidities in patients with epilepsy must consider not only the potential therapeutic effect of the drug, but also its potential iatrogenic effects on the seizure disorder.
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Affiliation(s)
- Kamil Detyniecki
- Comprehensive Epilepsy Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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Leeman-Markowski BA, Adams J, Martin SP, Devinsky O, Meador KJ. Methylphenidate for attention problems in epilepsy patients: Safety and efficacy. Epilepsy Behav 2021; 115:107627. [PMID: 33360744 PMCID: PMC7884102 DOI: 10.1016/j.yebeh.2020.107627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of seizures, and children with epilepsy have an increased prevalence of ADHD. Adults with epilepsy often have varying degrees of attentional dysfunction due to multiple factors, including anti-seizure medications, frequent seizures, interictal discharges, underlying lesions, and psychiatric comorbidities. Currently, there are no approved medications for the treatment of epilepsy-related attentional dysfunction. Methylphenidate (MPH) is a stimulant, FDA-approved for the treatment of ADHD, and often used for ADHD in the setting of pediatric epilepsy. Large database and registry studies indicate safety of MPH in children with ADHD and epilepsy, with no significant effect on seizure frequency. Small single-dose and open-label studies suggest efficacy of MPH in adults with epilepsy-related attention deficits. Methylphenidate represents a possible treatment for attentional dysfunction due to epilepsy, but large, randomized, placebo-controlled, double-blinded studies are needed.
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Affiliation(s)
- Beth A Leeman-Markowski
- Research Service, VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY 10010, United States; Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States.
| | - Jesse Adams
- Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305-5723, United States.
| | - Samantha P Martin
- Research Service, VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY 10010, United States; Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States.
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States; Department of Neurosurgery, New York University Langone Health, 660 1st Ave. #5, New York, NY 10016, United States; Department of Psychiatry, New York University Langone Health, 550 1st Ave., New York, NY 10016, United States.
| | - Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979 (room 2856), Palo Alto, CA 94304-5979, United States.
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Abstract
PURPOSE OF REVIEW Attention deficit/hyperactivity disorder (ADHD) is a frequent comorbidity in patients with epilepsy and is associated with important psychosocial and academic consequences. Evidence are now available to guide diagnosis and treatment of patients with both ADHD and epilepsy. RECENT FINDINGS The prevalence of ADHD varies from 12 to 39% in patients with newly diagnosed epilepsy to 70% in drug-resistant epilepsy. The diagnosis of ADHD requires parent-validated and teacher-validated rating scales, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and DSM-V, to confirm the information in the rating scales by interviewing parents and to exclude other causes of symptoms. Treatment with methylphenidate is associated with clinically significant improvement of ADHD symptoms in 60-75% of patients. Recent data reinforce the hypothesis that ADHD medications do not increase risk of seizures, even in patients with epilepsy. Beyond pharmacological management, experts have recommended to include multidisciplinary involvement in transition clinics for patients with both comorbid ADHD and epilepsy. SUMMARY Management of ADHD in patients with epilepsy requires implementation of evidence-based data in clinical practice both for diagnosis and treatment. Currently, there is no specific treatment of ADHD associated with epilepsy and its treatment is based on the usual treatments of ADHD, with reassuring data about their safety in epilepsy.
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Jansson JS, Hallböök T, Reilly C. Intellectual functioning and behavior in Dravet syndrome: A systematic review. Epilepsy Behav 2020; 108:107079. [PMID: 32334365 DOI: 10.1016/j.yebeh.2020.107079] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dravet syndrome (DS) is a developmental and epileptic encephalopathy with onset in the first year of life. At onset, the child displays normal development, but during the second year of life, stagnation/slowing of neurodevelopment is seen. In addition to difficulties with intellectual development, many children display behavioral problems including autistic features, and difficulties with attention and hyperactivity. AIM The aim of the present study was to systematically review studies that have focused on the prevalence of cognitive/developmental quotients (DQs) consistent with intellectual disability (ID), deficits in adaptive behavior, autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), and behavioral difficulties. A secondary aim was to consider possible factors associated with intellectual and behavioral outcomes in individuals with DS. METHOD A systematic review using PubMed and Scopus following the Preferred Reporting Items for Systematic Review (PRISMA) guidelines was conducted on the 24th of September 2019. Study quality was rated by two researchers using the National Institutes of Health (NIH) Quality assessment tools. RESULT Twenty-nine studies met inclusion criteria. The pooled prevalence of ID was 86% (range across studies: 50%-100%). The pooled prevalence for ASD was 31%. The mean level of adaptive behavior was more than 2 standard deviations (SDs) below average. The prevalence of behavioral difficulties on standardized instruments ranged between 37% and 100%. The only factor consistently associated with lower cognitive scores was age with older children having significantly lower cognitive scores than younger children. For behavioral difficulties, the most consistent association was with low health-related quality of life (HRQoL) with better HRQoL associated with fewer behavioral difficulties. Study quality was almost universally poor or fair - 15/29 studies were rated 'poor', 13/29 studies were 'fair', and 1 was 'good'. DISCUSSION The prevalence of cognitive scores consistent with ID is very high in DS. Many patients also have significant deficits in adaptive behavior highlighting that the majority of patients with DS will meet criteria for ID. The prevalence of ASD would also appear to be higher than the general population but studies show a wide range. Behavioral difficulties are common, but most studies have not used instruments adapted to patients with low intelligence quotient/DQ (IQ/DQ). No study used standardized instruments to assess ADHD. Few studies have used comprehensive statistical methods to evaluate possible factors associated with worse cognitive and behavioral outcome. CONCLUSION It should be routine to screen for cognitive and behavioral difficulties for all patients with DS. There is a need for more robust studies regarding intellectual and behavioral disorders in patients with DS. These should be large population-based or multinational studies that employ standardized instruments.
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Affiliation(s)
- Josefine Soto Jansson
- Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tove Hallböök
- Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Colin Reilly
- Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Park KJ, Ahn H, Yum MS, Ko TS, Kim HW. Treatment of Children and Adolescents with Epilepsy with Atomoxetine. Psychiatry Investig 2020; 17:412-416. [PMID: 32295327 PMCID: PMC7265023 DOI: 10.30773/pi.2019.0287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/11/2020] [Accepted: 02/22/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the effectiveness and safety of atomoxetine in Korean children and adolescents with epilepsy. METHODS We retrospectively reviewed the electronic medical records of 105 children and adolescents with epilepsy treated with atomoxetine. Effectiveness was measured with the Clinical Global Impressions-Severity (CGI-S) and/or Clinical Global Impressions-Improvement (CGI-I) scales at baseline, and after 4 and 12 weeks. We defined response to atomoxetine as a CGI-I score less than three at week 12. Safety was evaluated at each visit, based on clinical assessment by a child and adolescent psychiatrist and reports from participants or their caregivers. RESULTS In total participants (n=105), 33 (31.4%) showed a response to treatment: a significant decrease in CGI-S scale score was observed over 12 weeks of atomoxetine treatment. The most common adverse event (AE) was decreased appetite (n=16, 15.2%), and life-threatening AEs were not observed. Seizure aggravation due to atomoxetine was observed in 7.6% (n=8) of total participants, and one of them discontinued atomoxetine. CONCLUSION Our results provide preliminary evidence of the effectiveness and safety of atomoxetine in children and adolescents with epilepsy.
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Affiliation(s)
- Kee Jeong Park
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunji Ahn
- Department of Pediatric Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Sun Yum
- Department of Pediatric Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Sung Ko
- Department of Pediatric Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo-Won Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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14
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The psychopharmacology of epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2019. [PMID: 31727213 DOI: 10.1016/b978-0-444-64012-3.00012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Epilepsy affects 1% of the world's population and is defined as two or more unprovoked seizures. Psychiatric conditions (depression, psychosis, anxiety, and attention deficit hyperactivity disorder (ADHD)) may coexist and are linked to negative seizure outcomes and poorer quality of life. There is an increasing body of evidence to suggest a bidirectional relationship between epilepsy and psychiatric disorders, which may imply shared pathophysiologic mechanisms. Extensive research has examined neurobiologic and neuroanatomic substrates for this association revealing some interesting similarities. Psychiatric disorders in people with epilepsy often go underdiagnosed and undertreated, due to fears of exacerbating psychiatric symptoms or provoking seizures, which may cause delays in optimal management. This chapter covers psychiatric conditions in epilepsy largely focusing on depressive disorders and psychotic disorders. Anxiety and ADHD in association with epilepsy are also discussed. Epidemiology, pathophysiologic mechanisms, and pharmacotherapies used to treat epilepsy and psychiatric disorders are also covered.
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16
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Greydanus DE, Cates KW, Sadigh N. Adverse effects of stimulant medications in children and adolescents: focus on drug abuse. Int J Adolesc Med Health 2019; 31:ijamh-2019-0175. [PMID: 31483757 DOI: 10.1515/ijamh-2019-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Kevin W Cates
- Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Nina Sadigh
- Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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Salpekar JA, Mula M. Common psychiatric comorbidities in epilepsy: How big of a problem is it? Epilepsy Behav 2019; 98:293-297. [PMID: 30149996 DOI: 10.1016/j.yebeh.2018.07.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
Psychiatric illness and epilepsy commonly co-occur in adults and in children and adolescents. Theories of comorbidity are complex, but recurring associations between the conditions suggest overlap that is more than simple co-occurrence. Common underlying pathophysiology may imply that epilepsy itself may constituently include psychiatric symptoms. Conditions such as depression or cognitive difficulties commonly occur and in some cases, are considered to be associated with specific epilepsy characteristics such as localization or seizure type. Regardless of etiologic attributions to psychiatric comorbidity, it is clear today that treatment for epilepsy needs to target psychiatric illness. In many cases, quality-of-life improvements depend more upon addressing psychiatric symptoms than seizures themselves. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
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Affiliation(s)
- Jay A Salpekar
- Kennedy Krieger Institute, Johns Hopkins University, USA.
| | - Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London, United Kingdom; Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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18
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Querido AL, van Hulst RA. Diving and attention deficit hyperactivity disorder. Diving Hyperb Med 2019; 49:41-47. [PMID: 30856666 DOI: 10.28920/dhm49.1.41-47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/07/2019] [Indexed: 12/18/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a psychiatric condition that affects attention, concentration, impulse control and awareness. Not only these symptoms, but also the medications used to treat ADHD (psychostimulants) pose a risk to both the diver and his or her buddy. This article presents guidelines for recreational diving in combination with ADHD and psychostimulants. These guidelines are based solely on 'expert' opinion and were adopted at a meeting of the Dutch Association for Diving Medicine in 2017.
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Affiliation(s)
- Abraham L Querido
- Praktijk Querido, Larenseweg 14, Hilversum, The Netherlands.,Corresponding author: Abraham L Querido, Praktijk Querido, Larenseweg 14, Hilversum, The Netherlands,
| | - Robert A van Hulst
- Department of Experimental Intensive Care and Anaesthesiology/Hyperbaric Medicine, Academic Medical Center, Amsterdam
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Naguy A. Psychopharmacotherapy of Attention Deficit-Hyperactivity Disorder in Children with Comorbid Conditions. Pediatr Neurol 2018; 82:7-12. [PMID: 29678368 DOI: 10.1016/j.pediatrneurol.2017.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
One or more comorbidities occur in up to 80% of children with attention deficit-hyperactivity disorder. Attention deficit-hyperactivity disorder is also over-represented in several special populations. Pharmacotherapy can be challenging in these individuals with other conditions due to a suboptimal therapeutic response and an increased likelihood of adverse reactions. This article reviews the evidence supporting the psychopharmacologic management attention deficit-hyperactivity disorder when it occurs in individuals with common comorbidities.
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Affiliation(s)
- Ahmed Naguy
- Al-Manara CAP Centre, Kuwait Centre for Mental Health (KCMH), Shuwaikh, Kuwait.
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20
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Liu X, Carney PR, Bussing R, Segal R, Cottler LB, Winterstein AG. Stimulants Do Not Increase the Risk of Seizure-Related Hospitalizations in Children with Epilepsy. J Child Adolesc Psychopharmacol 2018; 28:111-116. [PMID: 29028437 PMCID: PMC5911707 DOI: 10.1089/cap.2017.0110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the safety of stimulants in children with epilepsy. METHODS In a retrospective cohort study based on Medicaid Analytic eXtract billing records from 26 U.S. states from 1999 to 2010, we identified incident stimulant use among children with epilepsy through outpatient encounter claims and pharmacy claims. We established a control group of nonusers and used frequency matching to generate index dates. We followed both cohorts for 12 months and calculated hazard ratios [HRs] of current and former use of stimulants versus no use on the outcome of seizure-related hospitalization using multivariate Cox proportional hazard models. RESULTS We identified 18,166 stimulant users and 54,197 nonusers in children with epilepsy. The incidence of seizure-related hospitalization in current stimulant users, former users, and nonusers was 3.6, 3.5, and 4.3 per 100 patient-years. After adjustment for confounders, we found current and former use of stimulants did not increase seizure-related hospitalizations (HR 0.95, 95% confidence interval [CI]: 0.83, 1.09 and HR 0.99, 95% CI: 0.85, 1.15). Children with cerebral palsy, congenital nervous system anomalies, or intellectual disability did not have significantly higher HRs than those without the already mentioned comorbidities. CONCLUSION This study has not identified any overall increase in the rate of seizure-related hospitalizations with the use of stimulants in children with epilepsy.
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Affiliation(s)
- Xinyue Liu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Paul R. Carney
- Department of Neurology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Linda B. Cottler
- Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
- Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
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21
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Childhood epilepsy and ADHD comorbidity in an Indian tertiary medical center outpatient population. Sci Rep 2018; 8:2670. [PMID: 29422636 PMCID: PMC5805699 DOI: 10.1038/s41598-018-20676-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/22/2018] [Indexed: 12/17/2022] Open
Abstract
This study aimed to assess the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and its characteristics and risk factors in children with epilepsy at a tertiary medical center in New Delhi. Children with active epilepsy, aged 6 to 12 years, were assessed for ADHD using DSM-IV-TR criteria. Epilepsy and psychiatric characteristics, sociodemographic indicators, and use of antiepileptic drugs were analyzed for differences between the ADHD and non-ADHD groups. Among the 73 children with epilepsy, 23% (n = 17) had comorbid ADHD, of whom 59% (n = 10) had predominantly inattentive type, 35% (n = 6) combined type, and 6% (n = 1) predominantly hyperactive-impulsive type. Lower IQ scores, epileptiform EEG activity, not attending school, and male sex were significantly associated with comorbid ADHD in children with epilepsy. Groups were similar in terms of age, socioeconomic indicators, family history of psychiatric disorders, seizure frequency in the last six months, seizure etiology, and seizure type. Epilepsy is a common pediatric neurological condition with frequent psychiatric comorbidities, including ADHD. Specialists should collaborate to optimize treatment for children with epilepsy and ADHD, especially for families in developing countries where the burden of disease can be great.
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22
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Ekinci O, Okuyaz Ç, Erdoğan S, Gunes S, Ekinci N, Kalınlı M, Teke H, Direk MÇ. Attention-Deficit Hyperactivity Disorder (ADHD) in Epilepsy and Primary ADHD: Differences in Symptom Dimensions and Quality of Life. J Child Neurol 2017; 32:1083-1091. [PMID: 29129152 DOI: 10.1177/0883073817737445] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to (1) compare quality of life (QOL) among children with epilepsy, epilepsy and attention-deficit hyperactivity disorder (ADHD), and primary ADHD and (2) compare ADHD symptom dimensions and subtypes between children with epilepsy-ADHD and primary ADHD. METHODS A total of 140 children; 53 with epilepsy, 35 with epilepsy-ADHD, and 52 with primary ADHD were included. KINDL-R (quality of life measure), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Parent Rating Scale (CPRS) were completed. Neurology clinic charts were reviewed for epilepsy-related variables. RESULTS Children with epilepsy-ADHD had the lowest (poorest) KINDL-R total scores. Epilepsy-ADHD group had more inattentiveness symptoms, whereas primary ADHD group had more hyperactivity/impulsivity symptoms. The frequencies of ADHD combined and inattentiveness subtypes were 60% and 40% in children with epilepsy-ADHD and 80.7% and 19.3% in children with primary ADHD, respectively ( P = .034). CONCLUSION ADHD in epilepsy is associated with a significantly poor quality of life and predominantly inattentiveness symptoms.
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Affiliation(s)
- Ozalp Ekinci
- 1 Department of Child and Adolescent Psychiatry, University of Health Sciences Medical Faculty, Istanbul, Turkey
| | - Çetin Okuyaz
- 2 Department of Pediatric Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Semra Erdoğan
- 3 Department of Biostatistics and Medical Informatics, Mersin University Medical Faculty, Mersin, Turkey
| | - Serkan Gunes
- 4 Department of Child and Adolescent Psychiatry, Hatay State Hospital, Hatay, Turkey
| | - Nuran Ekinci
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
| | - Merve Kalınlı
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
| | - Halenur Teke
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
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Vidaurre J, Twanow JDE. Attention Deficit Hyperactivity Disorder and Associated Cognitive Dysfunction in Pediatric Epilepsy. Semin Pediatr Neurol 2017; 24:282-291. [PMID: 29249508 DOI: 10.1016/j.spen.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric comorbidity associated with childhood epilepsy, affecting about a third of children with epilepsy. In contrast, ADHD in the general population occurs in 4%-12% of school-aged children. The cause of this association remains unclear. It is likely that common mechanisms underlie the vulnerability for both executive deficits and epileptogenesis. There are characteristics unique to children with ADHD and epilepsy. The inattentive type of ADHD is more prevalent than the combined presentation in children with epilepsy, while the combined type is more common in the general population. Interestingly, there is an equal sex distribution of ADHD in patients with epilepsy, while in the general population, ADHD is 3-7 times more prevalent in boys. Specific features of ADHD seen in different epilepsy syndromes are frequently associated with executive deficits. Early screening of ADHD symptoms in children with epilepsy is essential, as timely interventions can improve academic and social function and outcomes. The mainstays of therapy include behavioral interventions and pharmacotherapy, with evidence demonstrating that stimulants are both safe and effective in children with ADHD and epilepsy.
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Affiliation(s)
- Jorge Vidaurre
- From the Pediatric Neurology-Epilepsy Division, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
| | - Jaime Dawn E Twanow
- From the Pediatric Neurology-Epilepsy Division, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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24
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Adams J, Alipio-Jocson V, Inoyama K, Bartlett V, Sandhu S, Oso J, Barry JJ, Loring DW, Meador KJ. Methylphenidate, cognition, and epilepsy: A 1-month open-label trial. Epilepsia 2017; 58:2124-2132. [DOI: 10.1111/epi.13917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jesse Adams
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - Valerie Alipio-Jocson
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - Katherine Inoyama
- Department of Neurology and Neurological Sciences; Stanford University; Stanford California U.S.A
| | - Victoria Bartlett
- Department of Neurology and Neurological Sciences; Stanford University; Stanford California U.S.A
| | - Saira Sandhu
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - Jemima Oso
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - John J. Barry
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - David W. Loring
- Department of Neurology; Emory University; Atlanta Georgia U.S.A
| | - Kimford J. Meador
- Department of Neurology and Neurological Sciences; Stanford University; Stanford California U.S.A
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25
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Modi AC, Wagner J, Smith AW, Kellermann TS, Michaelis R. Implementation of psychological clinical trials in epilepsy: Review and guide. Epilepsy Behav 2017; 74:104-113. [PMID: 28734195 DOI: 10.1016/j.yebeh.2017.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/11/2017] [Indexed: 01/15/2023]
Abstract
The International League Against Epilepsy (ILAE) Neuropsychiatry commission and United States Institute of Medicine report both identified cognitive and psychological comorbidities as a significant issue for individuals with epilepsy, with rates as high as 60%. However, there is a paucity of evidence-based treatments for many psychological conditions (e.g., learning disorders, cognitive disorders, behavioral disorders). Because of inherent challenges in the implementation of psychological therapy trials and specific considerations for the population with epilepsy, the focus of the current review was to provide guidance and recommendations to conduct psychological trials for individuals with epilepsy. Several key areas will be discussed, including selection of patients, trial design, psychological intervention considerations, outcomes and evaluation of results, publication of trial results, and special issues related to pediatric clinical trials. Rigorously designed psychological therapy trials will set the stage for evidence-based practice in the care of individuals with epilepsy, with the goal of improving seizures, side effects, and HRQOL.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
| | - Janelle Wagner
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA; Comprehensive Epilepsy Program, Medical University of South Carolina, Charleston, SC, USA; Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee W Smith
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
| | - Tanja S Kellermann
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rosa Michaelis
- Department of Psychiatry, St. Marien-Hospital, Hamm, Germany; Integrative Curriculum for Anthroposophic Medicine (ICURAM), University Witten/Herdecke, Witten, Germany
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Williams TS, McDonald KP, Roberts SD, Dlamini N, deVeber G, Westmacott R. Prevalence and Predictors of Learning and Psychological Diagnoses Following Pediatric Arterial Ischemic Stroke. Dev Neuropsychol 2017; 42:309-322. [DOI: 10.1080/87565641.2017.1353093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Tricia S. Williams
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyla P. McDonald
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha D. Roberts
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gabrielle deVeber
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Zhang H, Zhao H, Feng HJ. Atomoxetine, a norepinephrine reuptake inhibitor, reduces seizure-induced respiratory arrest. Epilepsy Behav 2017; 73:6-9. [PMID: 28605634 PMCID: PMC5545072 DOI: 10.1016/j.yebeh.2017.04.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 12/31/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a devastating epilepsy complication, and no effective preventive strategies are currently available for this fatal disorder. Clinical and animal studies of SUDEP demonstrate that seizure-induced respiratory arrest (S-IRA) is the primary event leading to death after generalized seizures in many cases. Enhancing brain levels of serotonin reduces S-IRA in animal models relevant to SUDEP, including the DBA/1 mouse. Given that serotonin in the brain plays an important role in modulating respiration and arousal, these findings suggest that deficits in respiration and/or arousal may contribute to S-IRA. It is well known that norepinephrine is an important neurotransmitter that modulates respiration and arousal in the brain as well. Therefore, we hypothesized that enhancing noradrenergic neurotransmission suppresses S-IRA. To test this hypothesis, we examined the effect of atomoxetine, a norepinephrine reuptake inhibitor (NRI), on S-IRA evoked by either acoustic stimulation or pentylenetetrazole in DBA/1 mice. We report the original observation that atomoxetine specifically suppresses S-IRA without altering the susceptibility to seizures evoked by acoustic stimulation, and atomoxetine also reduces S-IRA evoked by pentylenetetrazole in DBA/1 mice. Our data suggest that the noradrenergic signaling is importantly involved in S-IRA, and that atomoxetine, a medication widely used to treat attention deficit hyperactivity disorder (ADHD), is potentially useful to prevent SUDEP.
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Affiliation(s)
- Honghai Zhang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Anesthesia, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Haiting Zhao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hua-Jun Feng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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28
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Downs J, Giust J, Dunn DW. Considerations for ADHD in the child with epilepsy and the child with migraine. Expert Rev Neurother 2017; 17:861-869. [PMID: 28749241 DOI: 10.1080/14737175.2017.1360136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Attention Deficit Hyperactivity Disorder (ADHD) is a common comorbid condition in children with epilepsy and migraine. Treatment of ADHD in children with epilepsy or migraine is essential but clinicians may overlook symptoms of ADHD and avoid appropriate use of medications that may reduce symptoms of ADHD without compromising treatment of epilepsy or migraine. Areas covered: PubMed was searched for articles on ADHD and epilepsy or migraine. Key papers were reviewed for additional articles. Areas of interest were: epidemiology, etiological factors, and treatment with emphasis on therapy. Expert commentary: Stimulant medication, especially methylphenidate, appears to be safe and effective in the treatment of ADHD in children with epilepsy or migraine. Unfortunately, data is limited with very few controlled trials of methylphenidate and very limited information on the use of amphetamines or non-stimulant drugs.
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Affiliation(s)
- Jennifer Downs
- a Indiana University School of Medicine , Department of Psychiatry , Indianapolis , IN , US
| | - Julianne Giust
- a Indiana University School of Medicine , Department of Psychiatry , Indianapolis , IN , US
| | - David W Dunn
- a Indiana University School of Medicine , Department of Psychiatry , Indianapolis , IN , US
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Williams TS, Roberts SD, Coppens AM, Crosbie J, Dlamini N, Westmacott R. Secondary attention-deficit/hyperactivity disorder following perinatal and childhood stroke: impact on cognitive and academic outcomes. Child Neuropsychol 2017; 24:763-783. [DOI: 10.1080/09297049.2017.1333091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tricia S. Williams
- Departments of Psychology & Psychiatry, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samantha D. Roberts
- Departments of Psychology & Psychiatry, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea M. Coppens
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jennifer Crosbie
- Departments of Psychology & Psychiatry, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Departments of Psychology & Psychiatry, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Departments of Psychology & Psychiatry, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
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Adams J, Alipio-Jocson V, Inoyama K, Bartlett V, Sandhu S, Oso J, Barry JJ, Loring DW, Meador K. Methylphenidate, cognition, and epilepsy: A double-blind, placebo-controlled, single-dose study. Neurology 2016; 88:470-476. [PMID: 28031390 DOI: 10.1212/wnl.0000000000003564] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/28/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the potential efficacy of immediate-release methylphenidate (MPH) for treating cognitive deficits in epilepsy. METHODS This was a double-blind, randomized, single-dose, 3-period crossover study in patients with epilepsy and chronic cognitive complaints comparing the effects of placebo and MPH 10 and 20 mg given 1 week apart. Cognitive outcome was evaluated on the basis of an omnibus z score calculated from performance on the Conners Continuous Performance Test 3 (ability to discriminate between target and nontarget stimuli [d'] and hit reaction time standard deviation), Symbol-Digit Modalities Test, and Medical College of Georgia Paragraph Memory Test. Adverse events and seizure frequency were monitored. An open-label follow-up is reported elsewhere. RESULTS Thirty-five adult patients with epilepsy participated, of whom 31 finished. Demographics included the following: mean age = 35.3 years (range 20-62 years), 13 men and 18 women, and baseline seizure frequency of 2.8 per month. Epilepsy types were focal (n = 24), generalized (n = 6), or unclassified (n = 1). Mean epilepsy duration was 12.5 years. A statistically significant performance benefit was present at both 10-mg (p = 0.030) and 20-mg (p = 0.034) MPH doses. No seizures were associated with either MPH dose. Adverse effects leading to withdrawal included cognitive "fogginess" (n = 1 on 20 mg), anxiety/agitation (n = 1 on 10 mg), and tachycardia (n = 1). One participant was lost to follow-up after one 20-mg dose without side effect. CONCLUSIONS This single-dose study suggests that MPH may be effective in ameliorating some cognitive deficits in patients with epilepsy. Additional studies are required. CLINICALTRIALSGOV IDENTIFIER NCT02178995. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that single doses of MPH improve cognitive performance on some measures of attention and processing speed in patients with epilepsy and cognitive complaints.
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Affiliation(s)
- Jesse Adams
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA.
| | - Valerie Alipio-Jocson
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Katherine Inoyama
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Victoria Bartlett
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Saira Sandhu
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Jemima Oso
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - John J Barry
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - David W Loring
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Kimford Meador
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
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Status Epilepticus Associated With Risperidone and Methylphenidate in an Adolescent With Epilepsy: A Case Report. J Clin Psychopharmacol 2016; 36:735-736. [PMID: 27662457 DOI: 10.1097/jcp.0000000000000578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ekinci O, Isik U, Gunes S, Yildirim C, Killi Y, Guler G. Self-concept in children and adolescents with epilepsy: The role of family functioning, mothers' emotional symptoms and ADHD. Brain Dev 2016; 38:714-22. [PMID: 26992474 DOI: 10.1016/j.braindev.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to identify the associated factors of poor self-concept in children and adolescents with epilepsy. METHODS Fifty-three patients with uncomplicated epilepsy (aged 7-18years) and 28 healthy controls were included. Study measures included the Piers-Harris 2 Self-Concept Scale, Family Assessment Device (FAD), Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners' Teacher Rating Scale (CTRS-R), Beck Depression Inventory and State-Trait Anxiety Inventory (STAI). Neurology clinic charts were reviewed for the epilepsy-related variables. RESULTS While the Piers-Harris 2 total score was not significantly different between the groups, patients with epilepsy had lower (poorer) scores on freedom from anxiety and popularity subscales. Linear regression analysis revealed that the problem solving, affective responsiveness, general functioning and communication scores of FAD; total and inattentiveness scores of T-DSM-IV-S and mothers' Beck scores were associated with the total score of Piers-Harris 2. Epilepsy-related factors were not found to be associated with self-concept scores. CONCLUSION Poor self-concept in children with epilepsy is associated with negative family functioning, mothers' emotional symptoms and ADHD, especially the symptoms of inattentiveness.
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Affiliation(s)
- Ozalp Ekinci
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey.
| | - Uğur Isik
- Department of Pediatrics, Division of Pediatric Neurology, Acıbadem University School of Medicine, Turkey
| | - Serkan Gunes
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
| | - Canan Yildirim
- Pediatric Neurology Department, Istanbul Erdem Hospital, Turkey
| | - Yunus Killi
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
| | - Gülen Guler
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
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Rheims S, Herbillon V, Villeneuve N, Auvin S, Napuri S, Cances C, Berquin P, Castelneau P, Nguyen The Tich S, Villega F, Isnard H, Nabbout R, Gaillard S, Mercier C, Kassai B, Arzimanoglou A. ADHD in childhood epilepsy: Clinical determinants of severity and of the response to methylphenidate. Epilepsia 2016; 57:1069-77. [PMID: 27237724 DOI: 10.1111/epi.13420] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is commonly observed in children with epilepsy. However, factors associated with the development of ADHD and which might help to guide its therapeutic management, remain an issue of debate. METHODS We conducted a multicenter prospective observational study that included children, aged 6-16 years, with both epilepsy and ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. After inclusion, patients entered a 12-16 week follow-up period during which they were either treated with methylphenidate or they did not receive specific ADHD treatment. ADHD was evaluated with the ADHD Rating Scale-IV. RESULTS One hundred sixty-seven patients were included, of which 91 were seizure-free during the preinclusion baseline period. At inclusion, the ADHD Rating Scale-IV total score was 30.4 ± (standard deviation) 9.2, the inattentive subscore was 17.3 ± 4.4, and the hyperactive subscore was 13.2 ± 6.6. We did not detect any difference of ADHD Rating Scale-IV scores across patients' age or gender, age at epilepsy onset, epilepsy syndrome, seizure frequency, or number of ongoing antiepileptic drugs. Methylphenidate was initiated in 61 patients, including 55 in whom a follow-up evaluation was available. At the last follow-up, 41 patients (75%) treated with methylphenidate and 39 (42%) of those who did not received ADHD therapy demonstrated ≥25% decrease of ADHD Rating Scale-IV total score (p < 0.001). Response to methylphenidate was greater in girls but was not influenced by any epilepsy-related variables. SIGNIFICANCE We did not detect any epilepsy-related factor associated with the severity of ADHD. Twenty-five percent of patients did not respond to methylphenidate. A better understanding of the pathologic process that underlies ADHD development in childhood epilepsy might be required to improve therapeutic strategies.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology and Epilepsy Institute (IDEE), Hospices Civils de Lyon and Lyon 1 University, Lyon, France.,Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France
| | - Vania Herbillon
- Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy, Sleep and Pediatric Neurophysiology Department, Hospices Civils de Lyon, Lyon, France
| | | | - Stéphane Auvin
- AP-HP, Department of Pediatric Neurology, Robert Debré Hospital, Paris, France
| | - Silvia Napuri
- Department of Pediatric Neurology, Rennes University Hospital, Rennes, France
| | - Claude Cances
- Department of Pediatric Neurology, Children Hospital, Toulouse, France
| | - Patrick Berquin
- Department of Pediatric Neurology, INSERM U1105 CURS, Amiens, France
| | - Pierre Castelneau
- Department of Pediatric Neurology, University Hospital of Tours, Tours, France
| | | | - Frédéric Villega
- Department of Pediatric Neurology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Rima Nabbout
- Pediatric Neurology Department, Reference Center for Rare Epilepsies, Necker Hospital, Paris, France
| | - Ségolène Gaillard
- Department of Clinical Pharmacology, EPICIME-CIC 1407 Inserm, Hospices Civils de Lyon, Lyon, France
| | | | - Behrouz Kassai
- Department of Clinical Pharmacology, EPICIME-CIC 1407 Inserm, Hospices Civils de Lyon, Lyon, France
| | - Alexis Arzimanoglou
- Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy, Sleep and Pediatric Neurophysiology Department, Hospices Civils de Lyon, Lyon, France
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Abstract
The treatment of epileptic seizure disorders is not restricted to the achievement of seizure-freedom, but must also include the management of comorbid medical, neurological, psychiatric and cognitive comorbidities. Psychiatric and neurological comorbidities are relatively common and often co-exist in people with epilepsy (PWE). For example, depression and anxiety disorders are the most common psychiatric comorbidities in PWE, and they are particularly common in PWE who also have a neurological comorbidity, such as migraine, stroke, traumatic brain injury or dementia. Moreover, psychiatric and neurological comorbodities often have a more severe impact on the quality of life in patients with treatment-resistant focal epilepsy than do the actual seizures. Epilepsy and psychiatric and neurological comorbidities have a complex relationship, which has a direct bearing on the management of both seizures and the comorbidities: the comorbidities have to be factored into the selection of antiepileptic drugs, and the susceptibility to seizures has to be considered when choosing the drugs to treat comorbidities. The aim of this Review is to highlight the complex relationship between epilepsy and common psychiatric and neurological comorbidities, and provide an overview of how treatment strategies for epilepsy can positively and negatively affect these comorbidities and vice versa.
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Williams AE, Giust JM, Kronenberger WG, Dunn DW. Epilepsy and attention-deficit hyperactivity disorder: links, risks, and challenges. Neuropsychiatr Dis Treat 2016; 12:287-96. [PMID: 26929624 PMCID: PMC4755462 DOI: 10.2147/ndt.s81549] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) has a prevalence rate of 7%-9% in the general population of children. However, in children with epilepsy, ADHD has been found to be present in 20%-50% of patients. This paper provides a review of ADHD prevalence in pediatric epilepsy populations and reviews data on specific symptom presentation and attention deficits in patients with epilepsy. This paper also reviews evidence-based treatments for ADHD and specifically the treatment of ADHD as a comorbid condition in children with epilepsy.
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Affiliation(s)
- Amy E Williams
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN, USA
| | - Julianne M Giust
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN, USA
| | - William G Kronenberger
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN, USA
| | - David W Dunn
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN, USA
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Socanski D, Aurlien D, Herigstad A, Thomsen PH, Larsen TK. Attention deficit/hyperactivity disorder and interictal epileptiform discharges: It is safe to use methylphenidate? Seizure 2015; 25:80-3. [DOI: 10.1016/j.seizure.2015.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/05/2014] [Accepted: 01/03/2015] [Indexed: 11/26/2022] Open
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Are children affected by epileptic neuropsychiatric comorbidities? Epilepsy Behav 2014; 38:8-12. [PMID: 24239433 DOI: 10.1016/j.yebeh.2013.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022]
Abstract
Childhood-onset epilepsy is associated with psychiatric and cognitive difficulties and with poor social outcomes in adulthood. Some antiepileptic drugs adversely affect behavior in susceptible children with easy-to-control or refractory epilepsies, contributing to a high risk of psychological and psychiatric disturbance. Studies had demonstrated that patients with benign rolandic epilepsy and absence epilepsy had more aggressive behavior, depression, and anxiety disorders than control children. Psychiatric comorbidities are strongly associated with a poor long-term health-related quality of life in childhood-onset epilepsy, which suggests that comprehensive epilepsy care must include screening and long-term treatment for these conditions, even if seizures remit.
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Salpekar JA, Mishra G. Key issues in addressing the comorbidity of attention deficit hyperactivity disorder and pediatric epilepsy. Epilepsy Behav 2014; 37:310-5. [PMID: 24835083 DOI: 10.1016/j.yebeh.2014.04.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/16/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common comorbidity of epilepsy encountered by clinicians. However, relatively little information is available to guide optimal diagnostic and treatment strategies. Differentiating ADHD from effects of epilepsy requires careful history taking and emphasis upon characteristic symptoms and course of illness. Rating scales for ADHD are well validated and may aid clinical management. Use of antiepileptic drugs may cause cognitive or behavioral side effects yet may improve behavior in some cases. Historically, clinicians have been hesitant to treat ADHD comorbidity for fear of lowering the seizure threshold. However, an aggregate of recent evidence now suggests that stimulants may be well tolerated and effective for ADHD comorbid with epilepsy. Studies that further clarify pathophysiology and treatment outcomes are needed in order to enhance clinical efficacy and quality of life for this population.
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Affiliation(s)
- Jay A Salpekar
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
| | - Gaurav Mishra
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA
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MacAllister WS, Vasserman M, Rosenthal J, Sherman E. Attention and Executive Functions in Children With Epilepsy: What, Why, and What to Do. APPLIED NEUROPSYCHOLOGY-CHILD 2014; 3:215-25. [PMID: 24559518 DOI: 10.1080/21622965.2013.839605] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fosi T, Lax-Pericall MT, Scott RC, Neville BG, Aylett SE. Methylphenidate treatment of attention deficit hyperactivity disorder in young people with learning disability and difficult-to-treat epilepsy: evidence of clinical benefit. Epilepsia 2014; 54:2071-81. [PMID: 24304474 PMCID: PMC4209117 DOI: 10.1111/epi.12399] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/29/2022]
Abstract
Purpose To establish the efficacy and safety of methylphenidate (MPH) treatment for attention deficit hyperactivity disorder (ADHD) in a group of children and young people with learning disability and severe epilepsy. Methods This retrospective study systematically reviewed the case notes of all patients treated with methylphenidate (MPH) for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) ADHD at a specialist epilepsy center between 1998 and 2005. Treatment efficacy was ascertained using clinical global impressions (CGI) scores, and safety was indexed by instances of >25% increase in monthly seizure count within 3 months of starting MPH. Key Findings Eighteen (18) patients were identified with refractory epilepsies (14 generalized, 4 focal), IQ <70, and ADHD. Male patients predominated (13:5) and ADHD was diagnosed at a median age of 11.5 years (range 6–18 years). With use of a combination of a behavioral management program and MPH 0.3–1 mg/kg/day, ADHD symptoms improved in 61% of patients (11/18; type A intraclass correlation coefficient of CGI 0.85, 95% confidence interval [CI] 0.69–0.94). Daily MPH dose, epilepsy variables, and psychiatric comorbidity did not relate to treatment response across the sample. MPH adverse effects led to treatment cessation in three patients (dysphoria in two, anxiety in one). There was no statistical evidence for a deterioration of seizure control in this group with the use of MPH. Significance Methylphenidate with behavioral management was associated with benefit in the management of ADHD in more than half of a group of children with severe epilepsy and additional cognitive impairments. Eighteen percent had significant side effects but no attributable increase in seizures. Methylphenidate is useful in this group and is likely to be under employed.
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Affiliation(s)
- Tangunu Fosi
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom
- Neurosciences Unit, UCL Institute of Child HealthLondon, United Kingdom
- Address correspondence to Tangunu Fosi, Neurosciences Unit (Wolfson Centre), UCL Institute of Child Health, 4/5 Long Yard, London WC1N 3LU, U.K. E-mail:
| | - Maria T Lax-Pericall
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- South London and Maudsley NHS Mental Health TrustLondon, United Kingdom
| | - Rod C Scott
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom
- Neurosciences Unit, UCL Institute of Child HealthLondon, United Kingdom
| | - Brian G Neville
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom
- Neurosciences Unit, UCL Institute of Child HealthLondon, United Kingdom
| | - Sarah E Aylett
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom
- Neurosciences Unit, UCL Institute of Child HealthLondon, United Kingdom
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Cortese S, Holtmann M, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Graham J, Taylor E, Sergeant J. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. J Child Psychol Psychiatry 2013; 54:227-46. [PMID: 23294014 DOI: 10.1111/jcpp.12036] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well-tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide evidence- and expert-based guidance concerning the management of (AEs) with medications for ADHD. METHODS For ease of use by practitioners and clinicians, the article is organized in a simple question and answer format regarding the prevalence and management of the most common AEs. Answers were based on empirical evidence from studies (preferably meta-analyses or systematic reviews) retrieved in PubMed, Ovid, EMBASE and Web of Knowledge through 30 June 2012. When no empirical evidence was available, expert consensus of the members of the European ADHD Guidelines Group is provided. The evidence-level of the management recommendations was based on the SIGN grading system. RESULTS The review covers monitoring and management strategies of loss of appetite and growth delay, cardiovascular risks, sleep disturbance, tics, substance misuse/abuse, seizures, suicidal thoughts/behaviours and psychotic symptoms. CONCLUSION Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.
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Affiliation(s)
- Samuele Cortese
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center of the NYU Langone Medical Center, New York, NY, USA.
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Dadashova R, Silverstone PH. Off-label use of atomoxetine in adults: is it safe? Ment Illn 2012; 4:e19. [PMID: 25478120 PMCID: PMC4253379 DOI: 10.4081/mi.2012.e19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 12/02/2022] Open
Abstract
Atomoxetine has been approved for the treatment of attention deficit/hyperactivity disorder in both adults and children. However, it is also being examined for several off-label uses in adults including mood disorders, eating disorders, cognitive dysfunction, and the treatment of addictions. Prior to such use it is important to examine the reported adverse events to see if this represents an appropriate level of risk. This is particularly important in the light of recent warnings from several regulatory bodies about an increase in blood pressure in a significant percentage of patients taking atomoxetine. To understand the risks a literature review was performed, and which identified the following potential problems. The first is that this drug should not be given in patients with known cardiovascular problems, and that all adult patients who receive atomoxetine should be monitored for changes in blood pressure throughout treatment. Secondly, there are several clinical situations in which atomoxetine should be closely monitored, or avoided, including patients who have a history or risk of narrow angle glaucoma, epileptic seizures, Tourette's syndrome, a history of urinary outflow obstruction, or who are pregnant or lactating. In conclusion, the current literature suggests that atomoxetine can be safely used off-label provided the above precautions are taken.
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Affiliation(s)
- Rana Dadashova
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
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Status epilepticus associated with the administration of long-acting methylphenidate in a 7-year-old girl. J Clin Psychopharmacol 2012; 32:300-2. [PMID: 22388167 DOI: 10.1097/jcp.0b013e3182499a16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim WW, Shim SH. A Case Report of Noonan Syndrome with Mental Retardation and Attention-Deficit Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2012. [DOI: 10.5765/jkacap.2012.23.1.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Hallett L, Foster T, Liu Z, Blieden M, Valentim J. Burden of disease and unmet needs in tuberous sclerosis complex with neurological manifestations: systematic review. Curr Med Res Opin 2011; 27:1571-83. [PMID: 21692602 DOI: 10.1185/03007995.2011.586687] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Tuberous sclerosis complex (TSC) is a progressive genetic disorder characterized by pervasive benign tumor growth. We sought to assess the current understanding of burden of TSC-related neurological manifestations. METHODS We systematically searched MEDLINE- and EMBASE-indexed, English-language literature (5/2000-5/2010) and non-indexed materials. RESULTS In total, 119 articles were included, 115 on epidemiology and treatment. Recent prevalence estimates from Ireland and Taiwan report TSC in 1:14,000-25,000 individuals, below older estimates of 1:10,000. While neurological manifestations are common, treatment is largely unaddressed by guidelines and focuses on symptoms, with resection standard for subependymal giant cell astrocytomas (SEGAs) and common practice for refractory epilepsy. Antiepileptic drugs and mammalian target of rapamycin inhibitors safely, effectively minimize the need for surgery for severe epilepsy and SEGAs. CONCLUSION Morbidity and treatment burden of prevalent neurological manifestations is significant, suggesting substantial economic and humanistic burden; however, these areas are poorly studied, indicating total disease burden is unknown. Future research should assess quality of life, caregiver burden, and costs.
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Abstract
Pediatric epilepsy is a common, chronic, and challenging physical illness for children and their families. This article provides a medical overview and discusses the cognitive functioning and psychosocial adjustment as well as the psychiatric management for children and adolescents with pediatric epilepsy. The management of these children involves establishing a collaborative health care approach, evaluating academic functioning, considering psychotherapy, and managing psychopharmacologic treatment. A thorough understanding of the biopsychosocial concerns in pediatric epilepsy can enable medical providers and mental health clinicians to promote resiliency and adaptation in children and their families facing troubling seizure disorders.
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Affiliation(s)
- I Simona Bujoreanu
- Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Koneski JAS, Casella EB, Agertt F, Ferreira MG. Efficacy and safety of methylphenidate in treating ADHD symptoms in children and adolescents with uncontrolled seizures: a Brazilian sample study and literature review. Epilepsy Behav 2011; 21:228-32. [PMID: 21524941 DOI: 10.1016/j.yebeh.2011.02.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is observed in 30% of children and adolescents with epilepsy. Recent studies have demonstrated the safety of methylphenidate (MPH) in patients with controlled epilepsy. There are few studies of patients with uncontrolled epilepsy. The goal was to study the efficacy and safety of MPH use in children and adolescents diagnosed with ADHD and uncontrolled epilepsy. METHODS We evaluated 24 patients ranging from 7 to 16 years of age who took MPH for 6 months. Inclusion criteria were at least two epileptic seizures in the previous 6 months and a diagnosis of ADHD based on DSM-IV criteria. CONCLUSION Patients were classified according to ADHD subtype as follows: 41.7% inattentive type, 37.5% combined, and 20.8% hyperactive/impulsive type; 58.3% had partial epilepsy and 41.7% generalized epilepsy. There was an overall improvement in ADHD symptoms in 70.8% of patients, and there was no increase in frequency of epileptic seizures in 22 patients (91.6%).
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Affiliation(s)
- Julio A S Koneski
- Faculty of Medicine of the University of Joinville, Clinica Neurologica, Joinville, SC, Brazil.
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Lo-Castro A, D'Agati E, Curatolo P. ADHD and genetic syndromes. Brain Dev 2011; 33:456-61. [PMID: 20573461 DOI: 10.1016/j.braindev.2010.05.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 11/28/2022]
Abstract
A high rate of Attention Deficit/Hyperactivity Disorder (ADHD)-like characteristics has been reported in a wide variety of disorders including syndromes with known genetic causes. In this article, we review the genetic and the neurobiological links between ADHD symptoms and some genetic syndromes such as: Fragile X Syndrome, Neurofibromatosis 1, DiGeorge Syndrome, Tuberous Sclerosis Complex, Turner Syndrome, Williams Syndrome and Klinefelter Syndrome. Although each syndrome may arise from different genetic abnormalities with multiple molecular functions, the effects of these abnormalities may give rise to common effects downstream in the biological pathways or neural circuits, resulting in the presentation of ADHD symptoms. Early diagnosis of ADHD allows for earlier treatment, and has the potential for a better outcome in children with genetic syndromes.
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Affiliation(s)
- Adriana Lo-Castro
- Department of Neuroscience, Paediatric Neurology Unit, "Tor Vergata" University of Rome, Italy.
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Reilly CJ. Attention deficit hyperactivity disorder (ADHD) in childhood epilepsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:883-893. [PMID: 21310586 DOI: 10.1016/j.ridd.2011.01.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 01/11/2011] [Indexed: 05/30/2023]
Abstract
ADHD and epilepsy common are both common childhood disorders and both can have significant negative consequences on a child's behavioural, learning, and social development. Both conditions can co-occur and population studies suggest that the prevalence of ADHD in childhood epilepsy is between 12 and 17%. The prevalence of epilepsy in ADHD is lower but it is not clear if the rate of epilepsy is higher in ADHD populations than in the general population. There is a higher occurrence of ADHD--Primarily Inattentive subtype in children with epilepsy and the reasons for this are not altogether clear but attention difficulties are very prevalent in childhood epilepsy. Seizure/epilepsy variables do not appear to be important correlates in most cases of ADHD in epilepsy although they may play a role in some cases. Individuals with both epilepsy and intellectual disability may be at higher risk for significant ADHD symptoms although screening and assessment in children with intellectual disability and epilepsy may be challenging. Children with epilepsy and ADHD are likely to be at higher risk for more negative outcomes in school and in terms of quality of life compared with children with epilepsy alone. Published studies on the treatment of ADHD in childhood epilepsy have focussed exclusively on the use of psychopharmacology and particularly methylphenidate. Although methylphenidate appears to be effective for some children with epilepsy the issue of whether it may lower seizure threshold continues to be debated. Children with epilepsy are at significant risk for ADHD and there is a need for more studies focussing on safe and efficacious interventions for symptoms of ADHD in this population.
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Affiliation(s)
- Colin J Reilly
- Research and Psychology Department, National Centre for Young People with Epilepsy, St Piers Lane, Lingfield, Surrey, RH76PW, United Kingdom.
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